Healthcare Provider Details

I. General information

NPI: 1982907226
Provider Name (Legal Business Name): ANNE H SELOVER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 WEST ONONDAGA ST. FAMILY PLANNING SERVICES
SYRACUSE NY
13202
US

IV. Provider business mailing address

4264 MONTEZUMA CRSE
LIVERPOOL NY
13090-6855
US

V. Phone/Fax

Practice location:
  • Phone: 315-435-3685
  • Fax:
Mailing address:
  • Phone: 315-491-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7138056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: