Provider Demographics
NPI:1417241803
Name:DUFFY-SEBERO, CARI L (NP)
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:L
Last Name:DUFFY-SEBERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 SOLVANG WAY
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208-8951
Mailing Address - Country:US
Mailing Address - Phone:920-863-2600
Mailing Address - Fax:
Practice Address - Street 1:629 SOLVANG WAY
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208-8951
Practice Address - Country:US
Practice Address - Phone:920-863-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4440-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4440-33OtherWI LICENSE
WI0000401600067Medicare Oscar/Certification