Healthcare Provider Details

I. General information

NPI: 1053345488
Provider Name (Legal Business Name): DEBORAH MARIE SEYMOUR APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2000
US

IV. Provider business mailing address

390 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2000
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-2101
  • Fax: 618-498-8153
Mailing address:
  • Phone: 618-498-7518
  • Fax: 618-498-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-006018
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: