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General NPI Number Information
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NPI Number | 1033494992
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Entity Type | Individual
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Provider Name | SANDRA SEWARD CSFA
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Gender | Female
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 11 CALLE PINON
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City | PLACITAS
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State | NM
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Zip | 87043-9316
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Country | US
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Telephone | 505-401-5264
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1956
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City | BERNALILLO
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State | NM
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Zip | 87004-1956
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Country | US
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Telephone | 505-401-5264
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 007339
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License Number State | NM
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