Provider Demographics
NPI:1205092798
Name:SEELEY, LINDA M (CNM/NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:SEELEY
Suffix:
Gender:F
Credentials:CNM/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 TEJAS PL
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9123
Mailing Address - Country:US
Mailing Address - Phone:805-929-3211
Mailing Address - Fax:805-929-6359
Practice Address - Street 1:2801 SANTA MARIA WAY
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-2118
Practice Address - Country:US
Practice Address - Phone:805-934-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380655163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70477FMedicaid
CA6350OtherNURSE PRACTITIONER
CA986OtherCNM