Provider Demographics
NPI:1578234621
Name:DE LEON, SELENA MARIE (APRN FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:MARIE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
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Mailing Address - Street 1:15480 S STURGEON DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-7007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23401 PRAIRIE STAR PKWY STE B-300
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7268
Practice Address - Country:US
Practice Address - Phone:913-677-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-80344-091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner