Provider Demographics
NPI:1417616434
Name:PEREZ, SELENA NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:NICOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 BRIGHTON HENRIETTA TOWN LINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2341
Mailing Address - Country:US
Mailing Address - Phone:585-230-2930
Mailing Address - Fax:
Practice Address - Street 1:1645 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2341
Practice Address - Country:US
Practice Address - Phone:585-230-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337763164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse