Provider Demographics
NPI:1497825657
Name:SEAL, VIVIAN HOLDER (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:HOLDER
Last Name:SEAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0249
Mailing Address - Country:US
Mailing Address - Phone:336-679-4963
Mailing Address - Fax:336-679-2549
Practice Address - Street 1:905 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5323
Practice Address - Country:US
Practice Address - Phone:336-648-8200
Practice Address - Fax:336-719-0013
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343936AMedicaid
99404OtherMEDCOST
NC343936CMedicaid
NC02774OtherBCBS
NC343936CMedicaid
NC343936AMedicaid