Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 3008560 | KY |
NPI | 1093107781 |
---|---|
Provider Name | Lecresha Sewell |
First Address | Louisville, KY 40241-3900 |
Second Address | Louisville, KY 40207-4707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2015 |
Last Update Date | 27/10/2020 |