Provider Demographics
NPI:1942386107
Name:SEVILLA, MAUREEN MARNELL (PA)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:MARNELL
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:7209 ROCKRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9747
Mailing Address - Country:US
Mailing Address - Phone:910-429-2668
Mailing Address - Fax:910-907-0704
Practice Address - Street 1:JOEL HEALTH CLINIC SRC
Practice Address - Street 2:WOMACK ARMY MEDCEN
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-9274
Practice Address - Fax:910-907-0704
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103313363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical