Provider Demographics
NPI:1811948060
Name:SEULING, HEIDI L (CRNA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:SEULING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 GRACIE CT
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9783
Mailing Address - Country:US
Mailing Address - Phone:812-941-0412
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:3706 GRACIE CT
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119
Practice Address - Country:US
Practice Address - Phone:812-941-0412
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005168367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100054170Medicaid
IN200897620Medicaid
Q66122Medicare UPIN
IN200897620Medicaid