Healthcare Provider Details

I. General information

NPI: 1225368103
Provider Name (Legal Business Name): VANESSA LOUISE SELIM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD
WARREN MI
48093-3472
US

IV. Provider business mailing address

1886 SEVERN RD
GROSSE POINTE WOODS MI
48236-1947
US

V. Phone/Fax

Practice location:
  • Phone: 586-576-4082
  • Fax:
Mailing address:
  • Phone: 313-530-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704229359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: