Basic Information
| Provider Information | |||||||||
| NPI: | 1578227492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SETERDAHL | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | BULL | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 561 FLAT HILLS RD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010021221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132217390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 329 CONWAY ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013011521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137746301 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2021 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2291170 | MA | N | Nursing Service Providers | Registered Nurse | 363L00000X | RN2291170 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.