Healthcare Provider Details

I. General information

NPI: 1225840770
Provider Name (Legal Business Name): CAROLYNE SEWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE BLDG 47
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

81 ARIZONA SUNSET RD NE
RIO RANCHO NM
87124-2538
US

V. Phone/Fax

Practice location:
  • Phone: 505-846-1723
  • Fax:
Mailing address:
  • Phone: 516-263-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-81366
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-81366
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: