Provider Demographics
NPI:1629045679
Name:SELBY, EMMA L (CNP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:L
Last Name:SELBY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2220
Mailing Address - Country:US
Mailing Address - Phone:513-631-3307
Mailing Address - Fax:513-867-2093
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:STE. 307
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2784
Practice Address - Country:US
Practice Address - Phone:513-867-2622
Practice Address - Fax:513-867-2093
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-03686363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SENP01062Medicare ID - Type Unspecified