1568614170 NPI number — MS. MELISSA SUZANNE BAGWELL-SEIFERT CRNP

Table of content: MS. MELISSA SUZANNE BAGWELL-SEIFERT CRNP (NPI 1568614170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568614170 NPI number — MS. MELISSA SUZANNE BAGWELL-SEIFERT CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAGWELL-SEIFERT
Provider First Name:
MELISSA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568614170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1965 AL HIGHWAY 157
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CULLMAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35058-0672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-775-2722
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1965 AL HIGHWAY 157
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CULLMAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35058-0672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-775-2722
Provider Business Practice Location Address Fax Number:
256-775-2648
Provider Enumeration Date:
10/14/2008

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: 363LP0200X , with the licence number:  1-087518 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 182072 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1-087518 . This is a "ALABAMA BOARD OF NURSING LICENSE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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