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NPI Code Detail

MEDICARE: BETH SEGERHOLM DNP, FNP-BC

MEDICARE: BETH SEGERHOLM DNP, FNP-BC
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
1363LF0000XFamily Nurse PractitionerAP11542AZ
2363LF0000XFamily Nurse Practitioner95018012CA

General Provider Information

NPI Number : 1548734536
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH SEGERHOLM DNP, FNP-BC
Provider Business Mailing Address
First Line : 106 SONORA ST
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92663-1741
Country : US
Telephone Number : 218-779-7178
Fax Number :
Provider Business Practice Location Address
First Line : 106 SONORA ST
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92663-1741
Country : US
Telephone Number : 218-779-7178
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2019
Last Update Date : 09/13/2022

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