Provider Demographics
NPI:1407454887
Name:PRAXIS GIRL, PC
Entity Type:Organization
Organization Name:PRAXIS GIRL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:319-440-7923
Mailing Address - Street 1:642 10TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3446
Mailing Address - Country:US
Mailing Address - Phone:319-440-7923
Mailing Address - Fax:
Practice Address - Street 1:642 10TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3446
Practice Address - Country:US
Practice Address - Phone:319-440-7923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1871899013Medicaid