Provider Demographics
NPI:1467071746
Name:SEYMOUR, WENDELL LAWRENCE (APRN)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:LAWRENCE
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 COUNTY ROAD 94 APT 14108
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-2993
Mailing Address - Country:US
Mailing Address - Phone:504-248-0891
Mailing Address - Fax:
Practice Address - Street 1:3800 COUNTY ROAD 94 APT 14108
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2993
Practice Address - Country:US
Practice Address - Phone:504-248-0891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily