Provider Demographics
NPI:1164231551
Name:SEGURA, ROXANA BERENICE
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:BERENICE
Last Name:SEGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7572 HOMESTEAD AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-1987
Mailing Address - Country:US
Mailing Address - Phone:651-367-4267
Mailing Address - Fax:
Practice Address - Street 1:122 W FRANKLIN AVE STE 323
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2452
Practice Address - Country:US
Practice Address - Phone:612-513-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker