Healthcare Provider Details

I. General information

NPI: 1255285136
Provider Name (Legal Business Name): ARISSA NICOLE SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CALLE DE LA NOCHE NE
ALBUQUERQUE NM
87109-3666
US

IV. Provider business mailing address

131 CALLE DE LA NOCHE NE
ALBUQUERQUE NM
87109-3666
US

V. Phone/Fax

Practice location:
  • Phone: 505-366-4197
  • Fax:
Mailing address:
  • Phone: 505-366-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number518181696
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: