Provider Demographics
NPI:1740920503
Name:SEWELL, JORDYN NICOLE (PA)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:NICOLE
Last Name:SEWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 GARDEN SPRING LN APT 207
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7505
Mailing Address - Country:US
Mailing Address - Phone:812-698-7095
Mailing Address - Fax:
Practice Address - Street 1:2151 OLD BRICK RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5837
Practice Address - Country:US
Practice Address - Phone:812-698-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant