Provider Demographics
NPI:1275782864
Name:SEALE, MARJORIE ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ELIZABETH
Last Name:SEALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:ELIZABETH
Other - Last Name:SEALE-SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:178 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4165
Mailing Address - Country:US
Mailing Address - Phone:845-471-1530
Mailing Address - Fax:
Practice Address - Street 1:178 CHURCH ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4165
Practice Address - Country:US
Practice Address - Phone:845-471-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10846363LW0102X
NYF360446363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health