Provider Demographics
NPI:1306113931
Name:SEWELL, SALLY ANN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANN
Last Name:SEWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1102 SAINT MARYS RD RM 1204
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4139
Mailing Address - Country:US
Mailing Address - Phone:785-762-3416
Mailing Address - Fax:785-762-3516
Practice Address - Street 1:1102 SAINT MARYS RD RM 1204
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4139
Practice Address - Country:US
Practice Address - Phone:785-762-3416
Practice Address - Fax:785-762-3516
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS557060367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered