Provider Demographics
NPI:1619669488
Name:SEACRIST, CHARLES EDDY III (RN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDDY
Last Name:SEACRIST
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:38401 MENTOR AVE UNIT 7303
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8760
Mailing Address - Country:US
Mailing Address - Phone:440-221-6634
Mailing Address - Fax:
Practice Address - Street 1:150 7TH AVE
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-2908
Practice Address - Country:US
Practice Address - Phone:440-285-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH430272163WC0200X
OH00208882367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine