Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0017001003 | VA |
NPI | 1003036690 |
---|---|
Provider Name | Cheryl Annette Segal |
First Address | Virginia Bch, VA 23451-1238 |
Second Address | Virginia Bch, VA 23462-2911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 26/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1861562472 | (05) | VA |