Healthcare Provider Details

I. General information

NPI: 1205838786
Provider Name (Legal Business Name): CAROL ROSE SEJDA RN, MN, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/13/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 N 9TH ST ST. BEN'S CLINIC
MILWAUKEE WI
53233-1411
US

IV. Provider business mailing address

6228 FOREST AVE
HAMMOND IN
46324-1011
US

V. Phone/Fax

Practice location:
  • Phone: 414-765-0606
  • Fax: 414-765-0226
Mailing address:
  • Phone: 219-932-3532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number73432-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: