Provider Demographics
NPI:1417772864
Name:SEIELSTAD, NERISSA
Entity type:Individual
Prefix:
First Name:NERISSA
Middle Name:
Last Name:SEIELSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 BRIDLE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-5304
Mailing Address - Country:US
Mailing Address - Phone:417-355-7183
Mailing Address - Fax:
Practice Address - Street 1:4407 BRIDLE RD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-5304
Practice Address - Country:US
Practice Address - Phone:417-355-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist