Provider Demographics
NPI:1851568612
Name:SEGUIN, THERESA A (WHNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:SEGUIN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 668
Mailing Address - Street 2:601 ELMWOOD AVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-487-3400
Mailing Address - Fax:585-334-3327
Practice Address - Street 1:500 RED CREEK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-487-3400
Practice Address - Fax:585-334-3327
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420873-1163WG0000X
NY387113-1163WG0000X
NY420873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF420873-1Medicare PIN