Provider Demographics
NPI:1487971537
Name:SEIFFERT, LORRAINE ROSENTHAL (ACNP)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:ROSENTHAL
Last Name:SEIFFERT
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:618-433-6006
Mailing Address - Fax:833-301-0853
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:STE 101
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6723
Practice Address - Country:US
Practice Address - Phone:618-433-6006
Practice Address - Fax:833-301-0853
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020856363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424219400Medicaid
MO424219400Medicaid
MO101740051Medicare PIN
MO101740051Medicaid
MOP00930654Medicare PIN
AR189664758Medicaid