Healthcare Provider Details

I. General information

NPI: 1003428988
Provider Name (Legal Business Name): DARLENE SEJOUR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CHERRY BLOSSOM CIR
WORCESTER MA
01605-0019
US

IV. Provider business mailing address

9 CHERRY BLOSSOM CIR
WORCESTER MA
01605-0019
US

V. Phone/Fax

Practice location:
  • Phone: 774-239-7719
  • Fax:
Mailing address:
  • Phone: 774-239-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN271788
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: