Healthcare Provider Details

I. General information

NPI: 1851568612
Provider Name (Legal Business Name): THERESA A SEGUIN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RED CREEK DR SUITE 120
ROCHESTER NY
14623
US

IV. Provider business mailing address

BOX 668 601 ELMWOOD AVE
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-487-3400
  • Fax: 585-334-3327
Mailing address:
  • Phone: 585-487-3400
  • Fax: 585-334-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberF420873-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number387113-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number420873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: