Provider Demographics
NPI:1063685725
Name:SEYMOUR, MARILYN
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1ST AND ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER
Mailing Address - State:SD
Mailing Address - Zip Code:57579-0281
Mailing Address - Country:US
Mailing Address - Phone:605-259-3121
Mailing Address - Fax:605-259-3444
Practice Address - Street 1:LST AND ROOSEVELT
Practice Address - Street 2:
Practice Address - City:WHTIE RIVER
Practice Address - State:SD
Practice Address - Zip Code:57579-0281
Practice Address - Country:US
Practice Address - Phone:605-259-3121
Practice Address - Fax:605-256-3444
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0004363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical