Provider Demographics
NPI:1942386107
Name:SEVILLA, MAUREEN MARNELL (PA)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:MARNELL
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:807 RAINFALL CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-0100
Mailing Address - Country:US
Mailing Address - Phone:910-728-3262
Mailing Address - Fax:
Practice Address - Street 1:1-2539 R MILLER STREET PUBLIC HEALTH CLINIC DPH
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1033132083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine