Provider Demographics
NPI:1568555621
Name:SEALE, NICOLE M (CRNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:SEALE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:300 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-2025
Mailing Address - Country:US
Mailing Address - Phone:334-382-2681
Mailing Address - Fax:334-383-9884
Practice Address - Street 1:101 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GEORGIANA
Practice Address - State:AL
Practice Address - Zip Code:36033-4268
Practice Address - Country:US
Practice Address - Phone:334-376-0380
Practice Address - Fax:334-376-0382
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-074541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871003533OtherGROUP NPI