Healthcare Provider Details

I. General information

NPI: 1316711617
Provider Name (Legal Business Name): KAILEY SEEDORF BSN, RN, CBS,CBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 AMARI LOOP NW
MANDAN ND
58554-1192
US

IV. Provider business mailing address

3915 AMARI LOOP NW
MANDAN ND
58554-1192
US

V. Phone/Fax

Practice location:
  • Phone: 952-846-8756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR48271
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: