Provider Demographics
NPI:1407154081
Name:SEYMORE, ELIZABETH R
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:SEYMORE
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 1:320 VANDERBILT AVE
Mailing Address - Street 2:APT 6 T
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3502
Mailing Address - Country:US
Mailing Address - Phone:718-682-1858
Mailing Address - Fax:
Practice Address - Street 1:320 VANDERBILT AVE
Practice Address - Street 2:APT 6 T
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3502
Practice Address - Country:US
Practice Address - Phone:718-682-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635854163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse