Provider Demographics
NPI:1104883420
Name:SELFE, KATHLEEN P (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:SELFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEW ENGLAND GERIATRICS
Mailing Address - Street 2:1132 WESTFIELD STREET
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-439-0090
Mailing Address - Fax:413-439-0096
Practice Address - Street 1:23 ACADIA RD
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4850
Practice Address - Country:US
Practice Address - Phone:508-771-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155375A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP33841Medicare UPIN
MANP3311Medicare PIN