Healthcare Provider Details

I. General information

NPI: 1629271739
Provider Name (Legal Business Name): TRACY LYNN SEGARS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DECATUR ST NW
WASHINGTON DC
20011-4343
US

IV. Provider business mailing address

606 14TH PL NE
WASHINGTON DC
20002-5416
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-4707
  • Fax: 202-723-4560
Mailing address:
  • Phone: 202-397-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN966369
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: