Provider Demographics
NPI:1376638262
Name:SEGUIN, ROSE M (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:M
Last Name:SEGUIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:CLEAR CREEK
Mailing Address - State:IN
Mailing Address - Zip Code:47426-0504
Mailing Address - Country:US
Mailing Address - Phone:812-824-8023
Mailing Address - Fax:812-824-8023
Practice Address - Street 1:421 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-1514
Practice Address - Country:US
Practice Address - Phone:812-336-7050
Practice Address - Fax:812-330-7352
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71000194A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner