Healthcare Provider Details

I. General information

NPI: 1669744876
Provider Name (Legal Business Name): DEBORAH HENDERSON SELAK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 FRAYSER BLVD SUITE A
MEMPHIS TN
38127-6439
US

IV. Provider business mailing address

1750 FRAYSER BLVD SUITE A
MEMPHIS TN
38127-6439
US

V. Phone/Fax

Practice location:
  • Phone: 901-358-0368
  • Fax: 901-358-9010
Mailing address:
  • Phone: 901-358-0368
  • Fax: 901-358-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number14290
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: