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NPI Code Detail

MEDICARE: MRS. MAGGI ANN SEYBOLD PA-C

MEDICARE: MRS. MAGGI ANN SEYBOLD PA-C
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
1363AS0400XSurgical Physician AssistantC0004220MD

General Provider Information

NPI Number : 1689981748
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MAGGI ANN SEYBOLD PA-C
Provider Business Mailing Address
First Line : 2841 BRYANT AVE S
Second Line : APARTMENT 524
City : MINNEAPOLIS
State : MN
Zip : 55408-2574
Country : US
Telephone Number : 419-410-1445
Fax Number :
Provider Business Practice Location Address
First Line : 2211 RIVERSIDE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55454-1350
Country : US
Telephone Number : 419-410-1445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2010
Last Update Date : 10/09/2014

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