Provider Demographics
NPI:1235777624
Name:SEGURA, CHARELLE TANEL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARELLE
Middle Name:TANEL
Last Name:SEGURA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHARELLE
Other - Middle Name:TANEL
Other - Last Name:TELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8211 SIGNAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2650
Mailing Address - Country:US
Mailing Address - Phone:505-459-0089
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM58408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner