Provider Demographics
NPI:1275635302
Name:SEIGLE, JERRIE L (LVN)
Entity Type:Individual
Prefix:MRS
First Name:JERRIE
Middle Name:L
Last Name:SEIGLE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:JERRIE
Other - Middle Name:L
Other - Last Name:SEIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:714 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6366
Mailing Address - Country:US
Mailing Address - Phone:801-426-6565
Mailing Address - Fax:
Practice Address - Street 1:714 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6366
Practice Address - Country:US
Practice Address - Phone:801-426-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 178624164X00000X
UT11829211-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse