Provider Demographics
NPI:1881664936
Name:SELANIK, VIRGINIA MICHELE (DNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MICHELE
Last Name:SELANIK
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 S IH 35 STE 1-E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4824
Mailing Address - Country:US
Mailing Address - Phone:512-978-9960
Mailing Address - Fax:512-776-0470
Practice Address - Street 1:6801 S IH 35 STE 1-E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4824
Practice Address - Country:US
Practice Address - Phone:512-978-9960
Practice Address - Fax:512-776-0470
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40156363LF0000X
TXAP139229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
550691297OtherSELECT NET PLUS
550691297OtherTRI CARE
WV001721073OtherBLUE CROSS
WV7105219000Medicaid
550691297Other4 MOST
WV001721073OtherBLUE CROSS
550691297Other4 MOST
WVNP13602Medicare PIN
WV2031792Medicare PIN
P96097Medicare UPIN
WV7105219000Medicaid
WV2031791Medicare PIN
WVWV0120DMedicare PIN