Provider Demographics
NPI:1700328044
Name:SELOGY, LISA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SELOGY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 MAXINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-3662
Mailing Address - Country:US
Mailing Address - Phone:330-265-4273
Mailing Address - Fax:
Practice Address - Street 1:2730 MAXINE AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-3662
Practice Address - Country:US
Practice Address - Phone:330-265-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136758164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse