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General NPI Number Information
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NPI Number | 1265687529
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Entity Type | Individual
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Provider Name | ERICA LENN SEAGRAVE CNIM
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Gender | Female
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Dates
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Enumeration Date | 11/28/2008
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 2500 DALLAS PKWY STE 500
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City | PLANO
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State | TX
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Zip | 75093-4805
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Country | US
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Telephone | 317-503-1350
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Fax |
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Provider Business Mailing Address
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Address Line | 17025 E LA MONTANA DR UNIT 132
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8583
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Country | US
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Telephone | 317-503-1350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472E0500X
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Taxonomy Name | EEG Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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