Provider Demographics
NPI:1477028520
Name:SEGURA, ELIZABETH MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:SEGURA
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:4921 PARKVIEW PL
Mailing Address - Street 2:STE 5A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-747-5900
Mailing Address - Fax:314-747-5936
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 5A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-5900
Practice Address - Fax:314-747-5936
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018034377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420061224Medicaid