Provider Demographics
NPI:1912316126
Name:MEDINA-SELLSTROM, VIRTUDES (BSN)
Entity Type:Individual
Prefix:
First Name:VIRTUDES
Middle Name:
Last Name:MEDINA-SELLSTROM
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21415 NORTH TANGLE CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388
Mailing Address - Country:US
Mailing Address - Phone:281-965-0144
Mailing Address - Fax:281-385-9749
Practice Address - Street 1:21415 N TANGLE CREEK LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4044
Practice Address - Country:US
Practice Address - Phone:832-246-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07865432246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy