Provider Demographics
NPI:1528344298
Name:SEGURA, PEGGY L (NP)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:SEGURA
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 1:10000 TELEGRAPH RD
Mailing Address - Street 2:EMERGENCY DEPT.
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3330
Mailing Address - Country:US
Mailing Address - Phone:313-295-5007
Mailing Address - Fax:313-295-6725
Practice Address - Street 1:38935 ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3397
Practice Address - Country:US
Practice Address - Phone:734-632-0175
Practice Address - Fax:734-632-0182
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGOtherCAQH
MIPENDINGMedicaid
MI4704240002OtherMEDICAL LICENSE