Healthcare Provider Details

I. General information

NPI: 1629987912
Provider Name (Legal Business Name): LAURA ELIZABETH BAKER-SELESKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4176 N GILWOOD DR
STOW OH
44224-2716
US

IV. Provider business mailing address

4176 N GILWOOD DR
STOW OH
44224-2716
US

V. Phone/Fax

Practice location:
  • Phone: 330-552-4000
  • Fax: 330-552-4001
Mailing address:
  • Phone: 330-552-4000
  • Fax: 330-552-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number065092
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: