Provider Demographics
NPI:1174328579
Name:SEGO, GREGORY (FNP-C, RN, BSN)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SEGO
Suffix:
Gender:
Credentials:FNP-C, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 N HIDDEN DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9176
Mailing Address - Country:US
Mailing Address - Phone:435-610-6720
Mailing Address - Fax:
Practice Address - Street 1:9905 N HIDDEN DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9176
Practice Address - Country:US
Practice Address - Phone:435-610-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10641919-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily