Provider Demographics
NPI:1295043966
Name:SELZ, JANET KIMBERLY (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:KIMBERLY
Last Name:SELZ
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 REHOBETH RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7600
Mailing Address - Country:US
Mailing Address - Phone:704-451-4359
Mailing Address - Fax:
Practice Address - Street 1:780 PATTON AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2438
Practice Address - Country:US
Practice Address - Phone:704-226-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4346363LA2200X
NC5008133363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health