Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704276691 | MI |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704276691 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704276691 | MI |
NPI | 1578182184 |
---|---|
Provider Name | Mr. Nicholas Robert Seliskar |
First Address | Saginaw, MI 48603-1194 |
Second Address | Saginaw, MI 48604-2834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2020 |
Last Update Date | 30/03/2021 |