Healthcare Provider Details

I. General information

NPI: 1740479492
Provider Name (Legal Business Name): THOMAS M SEIVERT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 GOLDEN CENTER DR
PLACERVILLE CA
95667-6260
US

IV. Provider business mailing address

4327 GOLDEN CENTER DR
PLACERVILLE CA
95667-6260
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-7700
  • Fax:
Mailing address:
  • Phone: 530-621-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberPA15547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: