Individual
SELENA MARIE DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
715 S 8TH ST, MINNEAPOLIS, MN 55404-1210
(612) 873-6963
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-3000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5532
MN
Other
Enumeration date
02/22/2018
Last updated
10/11/2023
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