Healthcare Provider Details

I. General information

NPI: 1629394507
Provider Name (Legal Business Name): MICHELLE SEAMSTER COOK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12522 W COLONIAL TRAIL HWY
CREWE VA
23930-0528
US

IV. Provider business mailing address

PO BOX 528 12522 W COLONIAL TRAIL HWY
CREWE VA
23930-0528
US

V. Phone/Fax

Practice location:
  • Phone: 434-645-9191
  • Fax: 434-645-1859
Mailing address:
  • Phone: 434-645-9191
  • Fax: 434-645-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164973
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: