Provider Demographics
NPI:1790590479
Name:SEELY, MIRANDA J
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:J
Last Name:SEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3820 MAJESTIC AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4100
Mailing Address - Country:US
Mailing Address - Phone:308-391-1051
Mailing Address - Fax:
Practice Address - Street 1:3820 MAJESTIC AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4100
Practice Address - Country:US
Practice Address - Phone:308-391-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion