Provider Demographics
NPI:1619117702
Name:SEELY, JILL ROBERTS
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ROBERTS
Last Name:SEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 W 1425 N
Mailing Address - Street 2:#35
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8994
Mailing Address - Country:US
Mailing Address - Phone:435-619-0489
Mailing Address - Fax:
Practice Address - Street 1:66 W HARDING AVE
Practice Address - Street 2:SUITE C7
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2695
Practice Address - Country:US
Practice Address - Phone:435-590-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program