Provider Demographics
NPI:1780978650
Name:SEEWALD, EMILY (APNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SEEWALD
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:C
Other - Last Name:GLIME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-433-3784
Mailing Address - Fax:920-433-7425
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-433-3784
Practice Address - Fax:920-433-7425
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4432-33363L00000X
WI16511130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI07028Medicare PIN
WIK400253503Medicare Oscar/Certification