MEDICARE: GINETTE SEAMANS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	808080	NY

General Provider Information

NPI Number	:	1417621160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINETTE SEAMANS RN

Provider Business Mailing Address
First Line	:	11744B HARVEST BLVD
Second Line	:
City	:	FORT DRUM
State	:	NY
Zip	:	13603-3130
Country	:	US
Telephone Number	:	207-217-1245
Fax Number	:

Provider Business Practice Location Address
First Line	:	11744B HARVEST BLVD
Second Line	:
City	:	FORT DRUM
State	:	NY
Zip	:	13603-3130
Country	:	US
Telephone Number	:	207-217-1245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	08/05/2021

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