Provider Demographics
NPI:1750933891
Name:SEIDEL, MERCEDES
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:SEIDEL
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 1:309 E GARFIELD ST APT F
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5729
Mailing Address - Country:US
Mailing Address - Phone:406-390-0361
Mailing Address - Fax:
Practice Address - Street 1:309 E GARFIELD ST APT F
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5729
Practice Address - Country:US
Practice Address - Phone:406-390-0361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-77425133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered