Provider Demographics
NPI:1184650673
Name:SELBY, LANA LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:LOUISE
Last Name:SELBY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-3337
Mailing Address - Country:US
Mailing Address - Phone:928-424-2110
Mailing Address - Fax:
Practice Address - Street 1:711 S 14TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-3337
Practice Address - Country:US
Practice Address - Phone:928-424-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR259120363LF0000X
AZ259120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11846506Medicaid
CAZZZ03524ZMedicare PIN
CAP92870Medicare UPIN