Provider Demographics
NPI:1437255437
Name:FLUKER, SELENA L (LPN)
Entity Type:Individual
Prefix:MS
First Name:SELENA
Middle Name:L
Last Name:FLUKER
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 1:26241 LAKE SHORE BLVD
Mailing Address - Street 2:#1769
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1177
Mailing Address - Country:US
Mailing Address - Phone:216-731-9323
Mailing Address - Fax:
Practice Address - Street 1:26241 LAKE SHORE BLVD
Practice Address - Street 2:#1769
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1177
Practice Address - Country:US
Practice Address - Phone:216-731-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH118898164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2422435Medicaid