Healthcare Provider Details

I. General information

NPI: 1932365434
Provider Name (Legal Business Name): TARA SELEEN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 N 9TH ST
MILWAUKEE WI
53233-1411
US

IV. Provider business mailing address

1027 N 9TH ST
MILWAUKEE WI
53233-1411
US

V. Phone/Fax

Practice location:
  • Phone: 414-765-0606
  • Fax: 414-765-0226
Mailing address:
  • Phone: 414-765-0606
  • Fax: 414-765-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number149961-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3578-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: