Provider Demographics
NPI:1043868003
Name:SEELBAUGH, JESSICA HARLEY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HARLEY
Last Name:SEELBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HARLEY
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1927
Mailing Address - Country:US
Mailing Address - Phone:724-979-2942
Mailing Address - Fax:
Practice Address - Street 1:617 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1927
Practice Address - Country:US
Practice Address - Phone:724-979-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN306485251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care