Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 91272 | CO |
NPI | 1003800301 |
---|---|
Provider Name | Victoria Segro |
First Address | Englewood, CO 80113 |
Second Address | Englewood, CO 80113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 13/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S42303 | (02) | CO |