Provider Demographics
NPI:1134826928
Name:VAN-SEGBEFIA, HENRIETTA YACOBAH
Entity type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:YACOBAH
Last Name:VAN-SEGBEFIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8570 EASTERN MORNING RUN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5863
Mailing Address - Country:US
Mailing Address - Phone:240-491-8830
Mailing Address - Fax:
Practice Address - Street 1:8570 EASTERN MORNING RUN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5863
Practice Address - Country:US
Practice Address - Phone:240-491-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186966363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology