Basic Information
| Provider Information | |||||||||
| NPI: | 1225494099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEIFARTH | ||||||||
| FirstName: | MARYSTUART | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | CRNP, BSN, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172682353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177653648 | ||||||||
| FaxNumber: | 7177653647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2016 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP015832 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1007307260043 | 01 | PA | MEDICAID GROUP # | OTHER | 867633 | 01 | PA | GROUP MEDICARE # | OTHER | 103090309 | 05 | PA | MEDICAID |