Provider Demographics
NPI:1902337363
Name:SELZER, MARK STEVEN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:SELZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1028
Mailing Address - Country:US
Mailing Address - Phone:440-536-1636
Mailing Address - Fax:
Practice Address - Street 1:78 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1028
Practice Address - Country:US
Practice Address - Phone:440-536-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner