Provider Demographics
NPI:1487328662
Name:SEATON, IVONNA MAE (NP)
Entity type:Individual
Prefix:
First Name:IVONNA
Middle Name:MAE
Last Name:SEATON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 W ASTER ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2226
Mailing Address - Country:US
Mailing Address - Phone:425-318-2761
Mailing Address - Fax:
Practice Address - Street 1:8283 GROVE AVE STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3140
Practice Address - Country:US
Practice Address - Phone:909-527-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60082679163W00000X
CA95170989163W00000X
CA95017587363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse