1083101547 NPI number — MRS. LEA MICHELLE SEALS MS, RD, LD, CSP

Table of content: MRS. LEA MICHELLE SEALS MS, RD, LD, CSP (NPI 1083101547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083101547 NPI number — MRS. LEA MICHELLE SEALS MS, RD, LD, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEALS
Provider First Name:
LEA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LD, CSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BISCHOFF
Provider Other First Name:
LEA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083101547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13159 ROEMER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47012-9531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-310-0533
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
518 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47012-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-310-0533
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1004X , with the licence number:  5395 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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