Provider Demographics
NPI:1336561422
Name:SEABURG, JENNY (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:SEABURG
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CHRISTINA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-9751
Mailing Address - Country:US
Mailing Address - Phone:585-690-6669
Mailing Address - Fax:
Practice Address - Street 1:142 CHRISTINA DR
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-9751
Practice Address - Country:US
Practice Address - Phone:585-690-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 581225163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health