Provider Demographics
NPI:1245794981
Name:SEYLER, MARY SUE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:SEYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAST MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702
Mailing Address - Country:US
Mailing Address - Phone:570-772-6171
Mailing Address - Fax:570-322-1023
Practice Address - Street 1:11 EAST MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702
Practice Address - Country:US
Practice Address - Phone:570-772-6171
Practice Address - Fax:570-322-1023
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide