Provider Demographics
NPI:1235360272
Name:SEUBERT, STEPHANIE LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SEUBERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:PINNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:330 S 12TH ST
Mailing Address - Street 2:SUITE 4710, MC 635
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1004
Mailing Address - Country:US
Mailing Address - Phone:612-596-7067
Mailing Address - Fax:612-466-9652
Practice Address - Street 1:330 S 12TH ST
Practice Address - Street 2:SUITE 4710, MC 635
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1004
Practice Address - Country:US
Practice Address - Phone:612-596-7067
Practice Address - Fax:612-466-9652
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 79245-7163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health