Provider Demographics
NPI:1275512410
Name:SEALE, ROBIN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:SEALE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0085
Mailing Address - Country:US
Mailing Address - Phone:601-260-2350
Mailing Address - Fax:601-706-4175
Practice Address - Street 1:3353 N GLOSTER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9735
Practice Address - Country:US
Practice Address - Phone:601-407-0334
Practice Address - Fax:601-407-0335
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR686891367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS430001587Medicare ID - Type Unspecified