Healthcare Provider Details

I. General information

NPI: 1902182488
Provider Name (Legal Business Name): KRYSTAL F SEGANTIM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 S MCCOLL RD
EDINBURG TX
78539-9152
US

IV. Provider business mailing address

4900 N MCCOLL RD UNIT 594
MCALLEN TX
78504-2351
US

V. Phone/Fax

Practice location:
  • Phone: 956-661-0529
  • Fax: 956-618-4639
Mailing address:
  • Phone: 956-661-0529
  • Fax: 956-618-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number87961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: