Provider Demographics
NPI:1134501943
Name:SEWARD, RICKIE LEONARD
Entity type:Individual
Prefix:
First Name:RICKIE
Middle Name:LEONARD
Last Name:SEWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MALIQUE
Other - Middle Name:A
Other - Last Name:SEWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:ALBERTA
Mailing Address - State:VA
Mailing Address - Zip Code:23821-0143
Mailing Address - Country:US
Mailing Address - Phone:434-532-3450
Mailing Address - Fax:434-848-2807
Practice Address - Street 1:218 TRAVIS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868
Practice Address - Country:US
Practice Address - Phone:434-848-5396
Practice Address - Fax:434-848-2807
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171WV0202X171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications