Healthcare Provider Details

I. General information

NPI: 1447263058
Provider Name (Legal Business Name): EILEEN JANE SEGALE RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COLUMBIA RD
DORCHESTER MA
02125-2322
US

IV. Provider business mailing address

500 COLUMBIA RD
DORCHESTER MA
02125
US

V. Phone/Fax

Practice location:
  • Phone: 617-740-8183
  • Fax: 617-282-7603
Mailing address:
  • Phone: 617-740-8183
  • Fax: 617-282-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number157804
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: