Basic Information
| Provider Information | |||||||||
| NPI: | 1336144062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEOLDO | ||||||||
| FirstName: | NATHALIE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3546 | ||||||||
| Address2: | |||||||||
| City: | CHINLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865033546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287243129 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | TSAILE HEALTH CENTER | ||||||||
| Address2: | ROUTE 64 & 12 | ||||||||
| City: | TSAILE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287243645 | ||||||||
| FaxNumber: | 9287243605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 13022 | AZ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.