Healthcare Provider Details

I. General information

NPI: 1568555621
Provider Name (Legal Business Name): NICOLE M SEALE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE M LAIRD CRNP

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHURCH ST
GEORGIANA AL
36033-4268
US

IV. Provider business mailing address

300 N COLLEGE ST
GREENVILLE AL
36037-2025
US

V. Phone/Fax

Practice location:
  • Phone: 334-376-0380
  • Fax: 334-376-0382
Mailing address:
  • Phone: 334-382-2681
  • Fax: 334-383-9884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-074541
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: