Provider Demographics
NPI:1164797536
Name:SEIDERS, CORIE ANN (ANP)
Entity Type:Individual
Prefix:MS
First Name:CORIE
Middle Name:ANN
Last Name:SEIDERS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29398 RECOVERY WAY
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-8447
Mailing Address - Country:US
Mailing Address - Phone:541-465-2662
Mailing Address - Fax:541-465-2657
Practice Address - Street 1:29398 RECOVERY WAY
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-8447
Practice Address - Country:US
Practice Address - Phone:541-465-2662
Practice Address - Fax:541-465-2657
Is Sole Proprietor?:No
Enumeration Date:2012-03-18
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091000435N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health