Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2011004379 | MO |
NPI | 1033417498 |
---|---|
Provider Name | Lisa Ann Seabaugh |
First Address | Saint Peters, MO 63376-1792 |
Second Address | Saint Louis, MO 63108-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2011 |
Last Update Date | 09/03/2011 |