Provider Demographics
NPI:1629141726
Name:SEALS, EZILEE THERESA (CRNA)
Entity Type:Individual
Prefix:
First Name:EZILEE
Middle Name:THERESA
Last Name:SEALS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 HERRON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:NC
Mailing Address - Zip Code:28789-8039
Mailing Address - Country:US
Mailing Address - Phone:828-586-1513
Mailing Address - Fax:828-586-7449
Practice Address - Street 1:68 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2722
Practice Address - Country:US
Practice Address - Phone:828-586-7000
Practice Address - Fax:828-586-7449
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34320367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8049941Medicaid
NC8049941Medicaid