Provider Demographics
NPI:1437159175
Name:SEGELKEN, HAZEL GRAMLING (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:GRAMLING
Last Name:SEGELKEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MIDLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8102
Mailing Address - Country:US
Mailing Address - Phone:843-875-6262
Mailing Address - Fax:843-873-7958
Practice Address - Street 1:312 MIDLAND PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8102
Practice Address - Country:US
Practice Address - Phone:843-875-6262
Practice Address - Fax:843-875-6262
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1892363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPN1892OtherBOARD OF NURSING
SC85321OtherBOARD OF NURSING