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General NPI Number Information
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NPI Number | 1578182184
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Entity Type | Individual
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Provider Name | NICHOLAS ROBERT SELISKAR NP
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Gender | Male
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 4701 TOWNE CENTRE RD
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City | SAGINAW
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State | MI
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Zip | 48604-2834
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Country | US
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Telephone | 989-790-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 4092 HEATHERMOOR DR
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City | SAGINAW
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State | MI
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Zip | 48603-1194
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Country | US
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Telephone | 989-928-5202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 4704276691
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704276691
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704276691
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License Number State | MI
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