Provider Demographics
NPI:1912771445
Name:HORNE, SELENA MARIE
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:MARIE
Last Name:HORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:MARIE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 BLUE BALL AVE
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5222
Mailing Address - Country:US
Mailing Address - Phone:406-206-0077
Mailing Address - Fax:410-620-6081
Practice Address - Street 1:212 BLUE BALL AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5222
Practice Address - Country:US
Practice Address - Phone:406-206-0077
Practice Address - Fax:410-620-6081
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL20010905164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse