Healthcare Provider Details

I. General information

NPI: 1336732098
Provider Name (Legal Business Name): BRIAN SEAFLER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2021
Last Update Date: 02/13/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 POCA FORK RD
ELKVIEW WV
25071-7169
US

IV. Provider business mailing address

1221 POCA FORK RD
ELKVIEW WV
25071-7169
US

V. Phone/Fax

Practice location:
  • Phone: 304-989-9741
  • Fax:
Mailing address:
  • Phone: 304-989-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108487
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: