Provider Demographics
NPI:1760016794
Name:SEGER, ERICA RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:RENEE
Last Name:SEGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 BROADWAY AVE.
Mailing Address - Street 2:LEVEL 1
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3633
Mailing Address - Country:US
Mailing Address - Phone:620-792-2511
Mailing Address - Fax:620-860-0619
Practice Address - Street 1:3515 BROADWAY AVE.
Practice Address - Street 2:LEVEL 1
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3633
Practice Address - Country:US
Practice Address - Phone:620-792-2511
Practice Address - Fax:620-860-0619
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-119979163W00000X
KS79718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201308760AMedicaid