Provider Demographics
NPI:1295576247
Name:SEYER, ETHAN (CRNA)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:SEYER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16155 STATE HIGHWAY D
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63769-5202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:434 N WEST ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1359
Practice Address - Country:US
Practice Address - Phone:573-547-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024020249367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered