Provider Demographics
NPI:1487256954
Name:SEGOVIA, GRACE ANNE (FNP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:SEGOVIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANNE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 GOVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1931
Mailing Address - Country:US
Mailing Address - Phone:617-569-5800
Mailing Address - Fax:617-568-4756
Practice Address - Street 1:10 GOVE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1931
Practice Address - Country:US
Practice Address - Phone:617-569-5800
Practice Address - Fax:617-568-4685
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2328789363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily