Provider Demographics
NPI:1225398449
Name:SEWELL, LERRAINE ODAY
Entity Type:Individual
Prefix:
First Name:LERRAINE
Middle Name:ODAY
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 1:1105 NALLEY RD
Mailing Address - Street 2:APT 841
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4425
Mailing Address - Country:US
Mailing Address - Phone:301-772-4042
Mailing Address - Fax:
Practice Address - Street 1:1105 NALLEY RD
Practice Address - Street 2:APT 841
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4425
Practice Address - Country:US
Practice Address - Phone:301-772-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS400546648517374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide