Provider Demographics
NPI:1134694821
Name:SEYMORE, CORINNE DAVISON
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:DAVISON
Last Name:SEYMORE
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 1:3621 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-5623
Mailing Address - Country:US
Mailing Address - Phone:504-564-4082
Mailing Address - Fax:504-436-1188
Practice Address - Street 1:3621 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-5623
Practice Address - Country:US
Practice Address - Phone:504-564-4082
Practice Address - Fax:504-436-1188
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver