Individual
MRS. KIERRA JAMBRE' SEWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5523 SEAWALL CT, VIRGINIA BEACH, VA 23462-7715
(757) 560-2055
Mailing address
5523 SEAWALL CT, VIRGINIA BEACH, VA 23462-7715
(757) 560-2055
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11150233
OUT OF NETWORK
VA
Enumeration date
05/09/2021
Last updated
05/09/2021
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