Provider Demographics
NPI:1558060988
Name:WARD, SELENA M
Entity Type:Individual
Prefix:MS
First Name:SELENA
Middle Name:M
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25143 LAHORE LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5922
Mailing Address - Country:US
Mailing Address - Phone:850-295-1471
Mailing Address - Fax:
Practice Address - Street 1:25143 LAHORE LN
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-5922
Practice Address - Country:US
Practice Address - Phone:850-295-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider