Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 38787 | NC |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 38787 | NC |
NPI | 1790723450 |
---|---|
Provider Name | Constance Jones Sewell |
First Address | Flat Rock, NC 28731-9447 |
Second Address | Flat Rock, NC 28731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 06/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38787 | MEDICAL DOCTOR (01) | NC |
8946924 | (05) | NC |
BJ2249630 | DEA (01) | NC |
E58361 | (02) | NC |
XJ2249630 | DEA (01) | NC |