Provider Demographics
NPI:1447992243
Name:SAGE MIDWIFERY, PLLC
Entity type:Organization
Organization Name:SAGE MIDWIFERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM, DEM
Authorized Official - Phone:703-662-3128
Mailing Address - Street 1:5663 RAVENEL LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2427
Mailing Address - Country:US
Mailing Address - Phone:703-662-3128
Mailing Address - Fax:
Practice Address - Street 1:5663 RAVENEL LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2427
Practice Address - Country:US
Practice Address - Phone:703-662-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty