Provider Demographics
NPI:1912764952
Name:SEWELL, SHAMICKA (RN,BSN)
Entity Type:Individual
Prefix:
First Name:SHAMICKA
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2397 DONNINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-2927
Mailing Address - Country:US
Mailing Address - Phone:334-546-1739
Mailing Address - Fax:
Practice Address - Street 1:2397 DONNINGTON WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-2927
Practice Address - Country:US
Practice Address - Phone:334-546-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95366419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse