Healthcare Provider Details

I. General information

NPI: 1871782607
Provider Name (Legal Business Name): CHRISTINA MARIE VON SEGGERN R.N., M.S.N., F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA MARIE DANIEL

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MORRISSEY BLVD UNIVERSITY HEALTH SERVICES
DORCHESTER MA
02125-3300
US

IV. Provider business mailing address

100 MORRISSEY BLVD UNIVERSITY HEALTH SERVICES
DORCHESTER MA
02125-3300
US

V. Phone/Fax

Practice location:
  • Phone: 617-287-5660
  • Fax: 617-287-3977
Mailing address:
  • Phone: 617-287-5660
  • Fax: 617-287-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number273054
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number273054
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: