Provider Demographics
NPI:1760491716
Name:SEEBURGER, VICKI A (RN MSN ONPC)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:A
Last Name:SEEBURGER
Suffix:
Gender:F
Credentials:RN MSN ONPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6262
Mailing Address - Country:US
Mailing Address - Phone:618-242-3778
Mailing Address - Fax:618-242-2551
Practice Address - Street 1:4121 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6262
Practice Address - Country:US
Practice Address - Phone:618-242-3778
Practice Address - Fax:618-242-2551
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL456840OtherMEDICARE GROUP PTAN
IL587680Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ILP09574Medicare UPIN