Healthcare Provider Details

I. General information

NPI: 1407436801
Provider Name (Legal Business Name): NICOLE SEGALINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 W 16TH ST
GREELEY CO
80634-2910
US

IV. Provider business mailing address

5881 W 16TH ST
GREELEY CO
80634-2910
US

V. Phone/Fax

Practice location:
  • Phone: 970-336-1500
  • Fax: 970-336-1505
Mailing address:
  • Phone: 970-336-1500
  • Fax: 970-336-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0074308
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: