Provider Demographics
NPI:1164689410
Name:SEWELL, LATOYA S (CRNP)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:S
Last Name:SEWELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:F
Other - Last Name:STUCKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 ROCKVILLE PIKE
Mailing Address - Street 2:BLDG. 10 CRC ROOM 7-3657
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-451-1670
Mailing Address - Fax:301-402-0180
Practice Address - Street 1:9000 ROCKVILLE PIKE
Practice Address - Street 2:BLDG. 10 CRC ROOM 7-3657
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-451-1670
Practice Address - Fax:301-402-0180
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN62746363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner