Provider Demographics
NPI:1518998772
Name:SEGER, MARY B (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:SEGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:SEGER-NOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:SUITE 298
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1595
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:989-731-7929
Practice Address - Street 1:829 N CENTER AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1595
Practice Address - Country:US
Practice Address - Phone:989-731-7870
Practice Address - Fax:989-731-7837
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47404155037363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1156900045OtherBCBSM PROVIDER NUMBER
OF96004OtherMEDICARE GROUP NUMBER
381303843OtherTAX ID
CC4805OtherMEDICARE RR PROV ID
OF96004OtherMEDICARE GROUP NUMBER
S66982Medicare UPIN