Provider Demographics
NPI:1992995526
Name:SEWALL, ANDREA MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:SEWALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:34 GILMAN ROAD
Mailing Address - Street 2:CONCENTRA
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-941-8300
Mailing Address - Fax:207-947-3134
Practice Address - Street 1:34 GILMAN ROAD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-941-8300
Practice Address - Fax:207-947-3134
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81858363LF0000X
MER048968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432710199Medicaid
ME230301OtherNHIC
ME200029OtherANTHEM
ME200029OtherANTHEM
ME432710199Medicaid
ME201836Medicare Oscar/Certification
ME201845Medicare Oscar/Certification
ME201837Medicare Oscar/Certification