Provider Demographics
NPI:1740779552
Name:LOSEE, SELENA MAE (DO)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:MAE
Last Name:LOSEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-602-9833
Mailing Address - Fax:319-343-1161
Practice Address - Street 1:403 1ST ST SE
Practice Address - Street 2:
Practice Address - City:BELMOND
Practice Address - State:IA
Practice Address - Zip Code:50421-1201
Practice Address - Country:US
Practice Address - Phone:844-474-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-055052084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADO05505OtherSTATE OF IOWA