Provider Demographics
NPI:1497326284
Name:SEWELL, NICHOLAS WHITNEY
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:WHITNEY
Last Name:SEWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:WHITNEY
Other - Last Name:SEWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1105 SW CRESTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2014
Mailing Address - Country:US
Mailing Address - Phone:509-432-6217
Mailing Address - Fax:
Practice Address - Street 1:1105 SW CRESTVIEW ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2014
Practice Address - Country:US
Practice Address - Phone:509-432-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61162664225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist