Healthcare Provider Details

I. General information

NPI: 1497363808
Provider Name (Legal Business Name): CAROLE SEIDE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 HAWORTH ST
PHILADELPHIA PA
19124-2508
US

IV. Provider business mailing address

1202 HAWORTH ST
PHILADELPHIA PA
19124-2508
US

V. Phone/Fax

Practice location:
  • Phone: 267-975-3192
  • Fax:
Mailing address:
  • Phone: 267-975-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberPN300474
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: