Provider Demographics
NPI:1558972737
Name:SEALE, TIA (RN)
Entity Type:Individual
Prefix:MS
First Name:TIA
Middle Name:
Last Name:SEALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19001 E 8 MILE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3247
Mailing Address - Country:US
Mailing Address - Phone:586-663-4755
Mailing Address - Fax:
Practice Address - Street 1:19001 E 8 MILE RD STE 102
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3247
Practice Address - Country:US
Practice Address - Phone:586-663-4755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704318799163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty