Provider Demographics
NPI:1689015802
Name:SEAL, TERESA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:SEAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RIO GRANDE CIR
Mailing Address - Street 2:4
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-9153
Mailing Address - Country:US
Mailing Address - Phone:859-814-1830
Mailing Address - Fax:
Practice Address - Street 1:20 RIO GRANDE CIR
Practice Address - Street 2:4
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-9153
Practice Address - Country:US
Practice Address - Phone:859-814-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164WOOOOOX164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse