Healthcare Provider Details

I. General information

NPI: 1154003366
Provider Name (Legal Business Name): SELINA A EHRAT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 STEIN BLVD
EAU CLAIRE WI
54701-6946
US

IV. Provider business mailing address

2403 FOLSOM ST
EAU CLAIRE WI
54703-2435
US

V. Phone/Fax

Practice location:
  • Phone: 715-836-9242
  • Fax:
Mailing address:
  • Phone: 715-552-9784
  • Fax: 715-835-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number150036
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14523
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253413
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: