Healthcare Provider Details

I. General information

NPI: 1861475238
Provider Name (Legal Business Name): KATHLEEN S SELHORST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E MAIN ST SUITE A
LEIPSIC OH
45856-9326
US

IV. Provider business mailing address

901 E MAIN ST SUITE A
LEIPSIC OH
45856-9326
US

V. Phone/Fax

Practice location:
  • Phone: 419-943-2130
  • Fax: 419-943-2146
Mailing address:
  • Phone: 419-943-2130
  • Fax: 419-943-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN-229364
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: