Basic Information
Provider Information
NPI: 1144681982
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEAVER
FirstName: BRIANNA
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 105 QUAIL DR
Address2:  
City: LAWRENCEBURG
State: TN
PostalCode: 384647164
CountryCode: US
TelephoneNumber: 9316299249
FaxNumber:  
Practice Location
Address1: 326 N LOCUST AVE
Address2:  
City: LAWRENCEBURG
State: TN
PostalCode: 384643516
CountryCode: US
TelephoneNumber: 9317629797
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/07/2016
LastUpdateDate: 03/07/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X20997TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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