Provider Demographics
NPI:1043264179
Name:SELBE, SUSAN L (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:SELBE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:25 JUNE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2621
Mailing Address - Country:US
Mailing Address - Phone:207-324-2146
Mailing Address - Fax:207-324-1288
Practice Address - Street 1:25A JUNE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2642
Practice Address - Country:US
Practice Address - Phone:207-324-2146
Practice Address - Fax:207-324-1288
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEAM082057367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0706221Medicaid
ME433411099Medicaid
S83254Medicare UPIN
MA0706221Medicaid