Basic Information
Provider Information
NPI: 1003291170
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEAVERS
FirstName: MICHELLE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5000 W NATIONAL AVE
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532950001
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 5000 W NATIONAL AVE
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532950001
CountryCode: US
TelephoneNumber: 4143842000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/29/2015
LastUpdateDate: 07/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X6511-33WIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home