Healthcare Provider Details

I. General information

NPI: 1194242925
Provider Name (Legal Business Name): JEANETTE LOUISE SEIDEL DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR BLDG 525
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

4628 W LONG LEAF DR
WEST JORDAN UT
84088-4948
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6913
  • Fax: 801-581-5060
Mailing address:
  • Phone: 801-243-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number352657-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number352657-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: