Provider Demographics
NPI:1356815112
Name:SEVALIE, NANAH HANNAH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:NANAH
Middle Name:HANNAH
Last Name:SEVALIE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 SUGAR PINE CT
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1153
Mailing Address - Country:US
Mailing Address - Phone:240-421-6507
Mailing Address - Fax:
Practice Address - Street 1:4041 POWDER MILL RD STE 206
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3106
Practice Address - Country:US
Practice Address - Phone:301-806-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR180839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily