Healthcare Provider Details

I. General information

NPI: 1134501943
Provider Name (Legal Business Name): RICKIE LEONARD SEWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MALIQUE A SEWARD

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 TRAVIS DR
LAWRENCEVILLE VA
23868
US

IV. Provider business mailing address

PO BOX 143
ALBERTA VA
23821-0143
US

V. Phone/Fax

Practice location:
  • Phone: 434-848-5396
  • Fax: 434-848-2807
Mailing address:
  • Phone: 434-532-3450
  • Fax: 434-848-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number171WV0202X
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: