Provider Demographics
NPI:1437876752
Name:SEYMOUR, ERIC KENNETH (RN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:KENNETH
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PEASE ST
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1651
Mailing Address - Country:US
Mailing Address - Phone:413-626-2921
Mailing Address - Fax:
Practice Address - Street 1:4 PEASE ST
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1651
Practice Address - Country:US
Practice Address - Phone:413-626-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse