Provider Demographics
NPI:1235561127
Name:SENECAL, KATHLEEN DORIS (FNP-C, MSN, CWCN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DORIS
Last Name:SENECAL
Suffix:
Gender:F
Credentials:FNP-C, MSN, CWCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 DAGAN CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6498
Mailing Address - Country:US
Mailing Address - Phone:907-750-9721
Mailing Address - Fax:
Practice Address - Street 1:2755 DAGAN CIR
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-6498
Practice Address - Country:US
Practice Address - Phone:907-750-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2019-06-19
Deactivation Date:2019-06-08
Deactivation Code:
Reactivation Date:2019-06-19
Provider Licenses
StateLicense IDTaxonomies
AK30133163WW0000X
AK146162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK146162OtherLICENSE NUMBER