Healthcare Provider Details

I. General information

NPI: 1881108157
Provider Name (Legal Business Name): SARABETH SEAGREAVES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 05/09/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N EISENHOWER AVE STE 110
MASON CITY IA
50401-1552
US

IV. Provider business mailing address

250 S CRESCENT DR
MASON CITY IA
50401-2926
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-2400
  • Fax:
Mailing address:
  • Phone: 641-494-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number119761
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: