Healthcare Provider Details

I. General information

NPI: 1396828679
Provider Name (Legal Business Name): IRENE D SEIDNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY SUITE 145
KNOXVILLE TN
37920-1500
US

IV. Provider business mailing address

1930 ALCOA HWY SUITE 145
KNOXVILLE TN
37920-1500
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-6650
  • Fax: 865-544-6572
Mailing address:
  • Phone: 865-544-6650
  • Fax: 865-544-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number35
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: