Provider Demographics
NPI:1174073019
Name:SEGATORE, STEPHEN JR (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:SEGATORE
Suffix:JR
Gender:M
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-2871
Mailing Address - Country:US
Mailing Address - Phone:508-637-1276
Mailing Address - Fax:
Practice Address - Street 1:450 W RIVER ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1435
Practice Address - Country:US
Practice Address - Phone:978-544-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily