Provider Demographics
NPI:1558804641
Name:SEAQUIST-GOBLE, ERIKA (APRN)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:SEAQUIST-GOBLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13624 S DANAUS WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-8930
Mailing Address - Country:US
Mailing Address - Phone:801-347-8545
Mailing Address - Fax:
Practice Address - Street 1:13624 S DANAUS WAY
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-8930
Practice Address - Country:US
Practice Address - Phone:801-347-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6975344-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily