Provider Demographics
NPI:1982255816
Name:SEELEY, REBECCA (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SEELEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BECKI
Other - Middle Name:
Other - Last Name:SEELEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25714
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0111
Mailing Address - Country:US
Mailing Address - Phone:855-587-4532
Mailing Address - Fax:
Practice Address - Street 1:8550 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8311
Practice Address - Country:US
Practice Address - Phone:217-430-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP049007202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology