Healthcare Provider Details

I. General information

NPI: 1265027031
Provider Name (Legal Business Name): SETA SETA ETIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10464 EVENING VIEW DR
FORT WORTH TX
76131-3968
US

IV. Provider business mailing address

10464 EVENING VIEW DR
FORT WORTH TX
76131-3968
US

V. Phone/Fax

Practice location:
  • Phone: 614-632-1935
  • Fax:
Mailing address:
  • Phone: 614-632-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number84732
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: