Healthcare Provider Details

I. General information

NPI: 1639623200
Provider Name (Legal Business Name): DARCEY A SEBOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 17TH ST
ROCK ISLAND IL
61201-5351
US

IV. Provider business mailing address

2701 17TH ST
ROCK ISLAND IL
61201-5351
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-2094
  • Fax: 309-779-2819
Mailing address:
  • Phone: 309-779-2094
  • Fax: 309-779-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: