Individual
SELENA NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.
Contact information
Practice address
1333 N 64TH PL, MESA, AZ 85205-4907
(480) 208-1790
Mailing address
1333 N 64TH PL, MESA, AZ 85205-4907
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
LM166
AZ
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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