Healthcare Provider Details

I. General information

NPI: 1063794584
Provider Name (Legal Business Name): NANCY W SELIX CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2011
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 W CALIFORNIA AVE
MILL VALLEY CA
94941-4449
US

IV. Provider business mailing address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

V. Phone/Fax

Practice location:
  • Phone: 415-497-3029
  • Fax:
Mailing address:
  • Phone: 510-437-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12072
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: