Provider Demographics
NPI:1194463901
Name:SEWELL, CLARA
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 ANSLEY ST APT A
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4473
Mailing Address - Country:US
Mailing Address - Phone:419-290-9126
Mailing Address - Fax:
Practice Address - Street 1:2357 ANSLEY ST APT A
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4473
Practice Address - Country:US
Practice Address - Phone:419-290-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant