Healthcare Provider Details

I. General information

NPI: 1801330998
Provider Name (Legal Business Name): SPIRIT SEELEY RN, MMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-5926
US

IV. Provider business mailing address

452 WINTHROP PL
HENDERSON NV
89074-5746
US

V. Phone/Fax

Practice location:
  • Phone: 562-537-8517
  • Fax:
Mailing address:
  • Phone: 562-537-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number872747
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: