Provider Demographics
NPI:1700532041
Name:SEAL, CLINTON THOMAS (CRNA)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:THOMAS
Last Name:SEAL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:CLINT
Other - Middle Name:
Other - Last Name:SEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:120 INNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9123
Mailing Address - Country:US
Mailing Address - Phone:985-234-0542
Mailing Address - Fax:985-892-7677
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-649-8767
Practice Address - Fax:985-649-8838
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA223981367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered