Healthcare Provider Details

I. General information

NPI: 1003036690
Provider Name (Legal Business Name): CHERYL ANNETTE SEGAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 INDEPENDENCE BLVD 126
VIRGINIA BCH VA
23462-2911
US

IV. Provider business mailing address

2900 ERIKSEN CT 126
VIRGINIA BCH VA
23451-1238
US

V. Phone/Fax

Practice location:
  • Phone: 757-385-0511
  • Fax: 757-743-5161
Mailing address:
  • Phone: 757-412-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0017001003
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: