Provider Demographics
NPI:1972780732
Name:SEWELL, NANCY W (RD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:W
Last Name:SEWELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 E LAKESHORE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4446
Mailing Address - Country:US
Mailing Address - Phone:951-471-4229
Mailing Address - Fax:
Practice Address - Street 1:2499 E LAKESHORE DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4446
Practice Address - Country:US
Practice Address - Phone:951-471-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA959115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered