Provider Demographics
NPI:1205838786
Name:SEJDA, CAROL ROSE (RN, MN, APNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ROSE
Last Name:SEJDA
Suffix:
Gender:F
Credentials:RN, MN, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1011
Mailing Address - Country:US
Mailing Address - Phone:219-932-3532
Mailing Address - Fax:
Practice Address - Street 1:1027 N 9TH ST
Practice Address - Street 2:ST. BEN'S CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1411
Practice Address - Country:US
Practice Address - Phone:414-765-0606
Practice Address - Fax:414-765-0226
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73432-030163W00000X
WI7-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43844500Medicaid