Provider Demographics
NPI:1114387628
Name:SEIDELL, NEOMI (MSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:NEOMI
Middle Name:
Last Name:SEIDELL
Suffix:
Gender:F
Credentials:MSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 BIRNIE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4409
Mailing Address - Country:US
Mailing Address - Phone:413-433-3810
Mailing Address - Fax:
Practice Address - Street 1:469 BIRNIE AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4409
Practice Address - Country:US
Practice Address - Phone:413-433-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282508163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant