1679669659 NPI number — MRS. SANDRA LEE SEEFELDT RNC APNP

Table of content: MRS. SANDRA LEE SEEFELDT RNC APNP (NPI 1679669659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679669659 NPI number — MRS. SANDRA LEE SEEFELDT RNC APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEEFELDT
Provider First Name:
SANDRA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RNC APNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAHL
Provider Other First Name:
SANDRA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1679669659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 HOGEBOOM AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAU CLAIRE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-832-9945
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STUDENT HEALTH SERVICE UW EAU CLAIRE
Provider Second Line Business Practice Location Address:
CREST WELLNESS CENTER
Provider Business Practice Location Address City Name:
EAU CLAIRE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-836-4311
Provider Business Practice Location Address Fax Number:
715-836-5979
Provider Enumeration Date:
10/05/2006

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: 363L00000X , with the licence number:  APNP 599033 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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