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General NPI Number Information
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NPI Number | 1568069748
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Entity Type | Individual
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Provider Name | SETH LIAM JAUSSEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1991 FORDHAM DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3773
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Country | US
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Telephone | 910-491-6793
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Fax | 833-428-3630
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Provider Business Mailing Address
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Address Line | PO BOX 39240
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City | BELFAST
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State | ME
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Zip | 04915-1234
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Country | US
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Telephone |
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Fax | 910-333-0513
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-10657
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License Number State | NC
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