Healthcare Provider Details

I. General information

NPI: 1619247129
Provider Name (Legal Business Name): KATHRYN RENAE SEIDL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N 92ND ST C-350
MILWAUKEE WI
53226-4875
US

IV. Provider business mailing address

999 N 92ND ST C-350
MILWAUKEE WI
53226-4875
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6943
  • Fax: 414-266-2926
Mailing address:
  • Phone: 414-266-6943
  • Fax: 414-266-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number180915
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: