Healthcare Provider Details

I. General information

NPI: 1205103041
Provider Name (Legal Business Name): KATRINA MEGAN SEAVEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W COWLES ST
FAIRBANKS AK
99701-5926
US

IV. Provider business mailing address

1717 W COWLES ST
FAIRBANKS AK
99701-5926
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-6682
  • Fax: 907-459-3976
Mailing address:
  • Phone: 907-451-6682
  • Fax: 907-459-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number6454
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number121877
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: