Provider Demographics
NPI:1770793895
Name:SEAMAN, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SEAMAN
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 1:4252 HOHE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7009
Mailing Address - Country:US
Mailing Address - Phone:907-235-0577
Mailing Address - Fax:907-235-6038
Practice Address - Street 1:4252 HOHE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7009
Practice Address - Country:US
Practice Address - Phone:907-235-0577
Practice Address - Fax:907-235-6038
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK70133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDT3225Medicaid