Provider Demographics
NPI:1558144360
Name:SELFWELL PLLC
Entity Type:Organization
Organization Name:SELFWELL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:913-669-4936
Mailing Address - Street 1:1011 S PEARL EXPY APT 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6111
Mailing Address - Country:US
Mailing Address - Phone:913-669-4936
Mailing Address - Fax:
Practice Address - Street 1:1011 S PEARL EXPY APT 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-6111
Practice Address - Country:US
Practice Address - Phone:913-669-4936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care