Provider Demographics
NPI:1023017290
Name:SEALEY, GLENDA R (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:R
Last Name:SEALEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130639
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0639
Mailing Address - Country:US
Mailing Address - Phone:903-595-4144
Mailing Address - Fax:903-596-7541
Practice Address - Street 1:1424 EAST FRONT
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8501
Practice Address - Country:US
Practice Address - Phone:903-595-4144
Practice Address - Fax:903-596-7541
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436067367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84116COtherBLUE CROSS BLUE SHIELD
TX84116CMedicare PIN