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General NPI Number Information
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NPI Number | 1689108490
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Entity Type | Individual
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Provider Name | LAVARE CANACE SELTUN NP
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Gender | Female
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 2015 AYRSLEY TOWN BLVD STE 202
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City | CHARLOTTE
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State | NC
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Zip | 28273-4068
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Country | US
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Telephone | 984-279-0776
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Fax |
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Provider Business Mailing Address
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Address Line | 4324 STONE MOUNTAIN DR
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City | GASTONIA
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State | NC
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Zip | 28054-0007
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Country | US
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Telephone | 980-745-2195
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5009482
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 23559
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5009482
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License Number State | NC
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