Healthcare Provider Details

I. General information

NPI: 1760043509
Provider Name (Legal Business Name): SAMANTHA LYNN SEWELL CPM. LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5663 RAVENEL LN
SPRINGFIELD VA
22151-2427
US

IV. Provider business mailing address

5663 RAVENEL LN
SPRINGFIELD VA
22151-2427
US

V. Phone/Fax

Practice location:
  • Phone: 703-662-3128
  • Fax: 206-984-4072
Mailing address:
  • Phone: 703-662-3128
  • Fax: 206-984-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129-000145
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: