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General NPI Number Information
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NPI Number | 1790085744
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Entity Type | Individual
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Provider Name | KRISTEN M SEABREASE NP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 3601 ODONNELL ST
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City | BALTIMORE
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State | MD
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Zip | 21224-5238
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Country | US
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Telephone | 443-618-6137
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 TALLY HO RD
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4725
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Country | US
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Telephone | 443-467-9377
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R170281
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R170281
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License Number State | MD
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