Provider Demographics
NPI:1154099828
Name:SEAVOLT, RACHEL (NP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SEAVOLT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1762
Mailing Address - Country:US
Mailing Address - Phone:517-212-2008
Mailing Address - Fax:517-212-2009
Practice Address - Street 1:4760 FASHION SQUARE BLVD STE L-1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2620
Practice Address - Country:US
Practice Address - Phone:989-282-4003
Practice Address - Fax:888-491-7220
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704272248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily