MEDICARE: MS. JENNIFER LYNN SEWELL CRNA

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	367500000X	Certified Registered Nurse Anesthetist	C02764	AR

General Provider Information

NPI Number	:	1760625305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LYNN SEWELL CRNA

Provider Business Mailing Address
First Line	:	4600 TOWSON AVE
Second Line	:	101-W2
City	:	FORT SMITH
State	:	AR
Zip	:	72901-7961
Country	:	US
Telephone Number	:	501-364-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 TOWSON AVE
Second Line	:	101-W2
City	:	FORT SMITH
State	:	AR
Zip	:	72901-7961
Country	:	US
Telephone Number	:	501-364-1100
Fax Number	:

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	07/07/2016

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