Provider Demographics
NPI:1144078122
Name:NOLTE, SELENA (PA-C)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:NOLTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 ALAINA DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-0440
Mailing Address - Country:US
Mailing Address - Phone:515-777-8310
Mailing Address - Fax:
Practice Address - Street 1:4906 ALAINA DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-0440
Practice Address - Country:US
Practice Address - Phone:515-777-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17950363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical