Healthcare Provider Details

I. General information

NPI: 1932966223
Provider Name (Legal Business Name): ABIGAIL SEIDLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9494 W NORTHERN AVE STE 101
GLENDALE AZ
85305-1119
US

IV. Provider business mailing address

19036 N 4TH ST
PHOENIX AZ
85024-2239
US

V. Phone/Fax

Practice location:
  • Phone: 623-872-2226
  • Fax:
Mailing address:
  • Phone: 636-346-4705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: