Individual
ANITRA JANELLE SEALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
51621 N DEMOSS RD, BENTON CITY, WA 99320-5177
(509) 588-2616
Mailing address
51621 N DEMOSS RD, BENTON CITY, WA 99320-5177
(509) 588-2616
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN00136247
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26-3376821
—
WA
Enumeration date
08/06/2012
Last updated
08/06/2012
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