Healthcare Provider Details

I. General information

NPI: 1366926511
Provider Name (Legal Business Name): LATONYA LYNN SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2018
Last Update Date: 09/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 WESLEYAN RD
DAYTON OH
45406-3607
US

IV. Provider business mailing address

1629 WESLEYAN RD
DAYTON OH
45406-3607
US

V. Phone/Fax

Practice location:
  • Phone: 937-287-2289
  • Fax:
Mailing address:
  • Phone: 937-287-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: