MEDICARE: MRS. HAZEL GRAMLING SEGELKEN CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	APN1892	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APN1892	OTHER	SC	BOARD OF NURSING
2	85321	OTHER	SC	BOARD OF NURSING

General Provider Information

NPI Number	:	1437159175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HAZEL GRAMLING SEGELKEN CPNP

Provider Business Mailing Address
First Line	:	312 MIDLAND PKWY
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8102
Country	:	US
Telephone Number	:	843-875-6262
Fax Number	:	843-873-7958

Provider Business Practice Location Address
First Line	:	312 MIDLAND PKWY
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8102
Country	:	US
Telephone Number	:	843-875-6262
Fax Number	:	843-875-6262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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