Provider Demographics
NPI:1437780608
Name:SELMAN, LAURA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SELMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-0226
Mailing Address - Country:US
Mailing Address - Phone:601-754-1033
Mailing Address - Fax:
Practice Address - Street 1:800 N CAUSEWAY BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4664
Practice Address - Country:US
Practice Address - Phone:985-892-7621
Practice Address - Fax:985-892-9245
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily