MEDICARE: DONNA JEAN SEWELL ARNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	ARNP1278502	FL

General Provider Information

NPI Number	:	1699745869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA JEAN SEWELL ARNP-C

Provider Business Mailing Address
First Line	:	515 CUTCHINS MILL RD
Second Line	:
City	:	CHIPLEY
State	:	FL
Zip	:	32428-4398
Country	:	US
Telephone Number	:	850-638-7563
Fax Number	:

Provider Business Practice Location Address
First Line	:	278 LASALLE LEFALL DR
Second Line	:
City	:	QUINCY
State	:	FL
Zip	:	32351-5324
Country	:	US
Telephone Number	:	850-875-7200
Fax Number	:	850-875-3618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/08/2007

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