Provider Demographics
NPI:1043285661
Name:SEECOF, JOHNETTE M (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHNETTE
Middle Name:M
Last Name:SEECOF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOHNETTE
Other - Middle Name:SPISSO
Other - Last Name:SEECOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-579-3272
Mailing Address - Fax:
Practice Address - Street 1:2450 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2179
Practice Address - Country:US
Practice Address - Phone:702-877-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN238892L367500000X
NVCRNA000484367500000X
NVRN84125163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV112247Medicare PIN
NVV112246Medicare PIN