Healthcare Provider Details

I. General information

NPI: 1053635748
Provider Name (Legal Business Name): BRENDA L SEIDEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 125
SAINT LOUIS MO
63141-8663
US

IV. Provider business mailing address

1235 GLENMEADE DR
MARYLAND HEIGHTS MO
63043-3618
US

V. Phone/Fax

Practice location:
  • Phone: 314-806-1770
  • Fax:
Mailing address:
  • Phone: 314-806-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010008797
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2090425177
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2010008797
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: