Provider Demographics
NPI:1710467618
Name:CAPAK, SELENA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:MARIE
Last Name:CAPAK
Suffix:
Gender:F
Credentials:LVN
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 309
Mailing Address - Street 2:
Mailing Address - City:LOLITA
Mailing Address - State:TX
Mailing Address - Zip Code:77971-0309
Mailing Address - Country:US
Mailing Address - Phone:361-827-1010
Mailing Address - Fax:
Practice Address - Street 1:173 PR 4261
Practice Address - Street 2:
Practice Address - City:LOLITA
Practice Address - State:TX
Practice Address - Zip Code:77971
Practice Address - Country:US
Practice Address - Phone:361-827-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339446164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse