Provider Demographics
NPI:1760063226
Name:SEIDL, CHRISTEN M
Entity Type:Individual
Prefix:MS
First Name:CHRISTEN
Middle Name:M
Last Name:SEIDL
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 1:1165 ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2615
Mailing Address - Country:US
Mailing Address - Phone:651-772-5575
Mailing Address - Fax:888-909-0983
Practice Address - Street 1:1165 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2615
Practice Address - Country:US
Practice Address - Phone:651-772-5575
Practice Address - Fax:651-772-5656
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8133363L00000X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health