Healthcare Provider Details

I. General information

NPI: 1639802218
Provider Name (Legal Business Name): JENNA ANN SEELEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA ANN SEELEY DO

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 W THUNDERBIRD RD
GLENDALE AZ
85306-3721
US

IV. Provider business mailing address

310 FELKNER RD
GRANTS PASS OR
97527-7556
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-1500
  • Fax:
Mailing address:
  • Phone: 541-761-5613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5151015926
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: