Provider Demographics
NPI:1326405309
Name:SOWELL, XUAN
Entity Type:Individual
Prefix:
First Name:XUAN
Middle Name:
Last Name:SOWELL
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 1:549 75TH WAY NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-9711
Mailing Address - Country:US
Mailing Address - Phone:469-442-9880
Mailing Address - Fax:
Practice Address - Street 1:400 COOPER POINT RD SW
Practice Address - Street 2:SUIT 26
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8705
Practice Address - Country:US
Practice Address - Phone:469-442-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60608773172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker