Provider Demographics
NPI:1932687761
Name:SEGOVIA, MARICELA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARICELA
Middle Name:
Last Name:SEGOVIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13601 PRESTON RD STE 210W
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4986
Mailing Address - Country:US
Mailing Address - Phone:972-702-0300
Mailing Address - Fax:
Practice Address - Street 1:2505 SCOTTI ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5882
Practice Address - Country:US
Practice Address - Phone:972-702-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX892935163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse