=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174337828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANNA NICOLE SEASE FNP BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7750 E FLORENTINE RD STE A
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-277-1211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 551 N MERCADO ST
-----------------------------------------------------
City | DEWEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86327-7117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-533-4217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 227900
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------