Provider Demographics
NPI:1245497494
Name:SELIG, GERTRUDE MARY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:MARY
Last Name:SELIG
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-584-4354
Mailing Address - Fax:216-584-4355
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-584-4354
Practice Address - Fax:216-584-4355
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106-22486163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN168536OtherOHIO STATE BOARD OF NURSING
VA106-22486OtherINTERNAT'L BD LACTATION CONSULTANT EXAMINERS