Healthcare Provider Details

I. General information

NPI: 1811948060
Provider Name (Legal Business Name): HEIDI L. SEULING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 GRACIE CT
FLOYDS KNOBS IN
47119
US

IV. Provider business mailing address

3706 GRACIE CT
FLOYDS KNOBS IN
47119-9783
US

V. Phone/Fax

Practice location:
  • Phone: 812-941-0412
  • Fax: --
Mailing address:
  • Phone: 812-941-0412
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3005168
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: