Healthcare Provider Details

I. General information

NPI: 1235680885
Provider Name (Legal Business Name): KAREN NICOLE SEGGERTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 MAKALAPA RD
HONOLULU HI
96817
US

IV. Provider business mailing address

400 MCGREW LOOP
AIEA HI
96701-4202
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-0247
  • Fax:
Mailing address:
  • Phone: 808-233-8916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number49228
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: