Basic Information
| Provider Information | |||||||||
| NPI: | 1003219320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEGUN | ||||||||
| FirstName: | STELLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8536 FREYMAN DR APT 213 | ||||||||
| Address2: | |||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208157819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404764415 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6856 EASTERN AVE NW | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200122165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025456980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2014 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN1002116 | DC | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | LPN1002116 | 01 | DC | STATE NURSING LICENCE | OTHER |