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General NPI Number Information
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NPI Number | 1437627247
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Entity Type | Individual
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Provider Name | CODY SEAMONS CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 600 EAST BLVD
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City | ELKHART
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State | IN
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Zip | 46514-2483
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Country | US
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Telephone | 574-294-2621
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Fax |
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Provider Business Mailing Address
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Address Line | 19620 GENTLE STREAM CIR
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City | GOSHEN
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State | IN
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Zip | 46528-6283
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Country | US
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Telephone | 208-681-9477
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28247128
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 123219
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License Number State | IN
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