Provider Demographics
NPI:1194505362
Name:HARSCH, SELINA L (LPN)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:L
Last Name:HARSCH
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 1:361 BONNIE BRAE AVE NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5212
Mailing Address - Country:US
Mailing Address - Phone:330-937-1715
Mailing Address - Fax:
Practice Address - Street 1:361 BONNIE BRAE AVE NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5212
Practice Address - Country:US
Practice Address - Phone:330-937-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.184115.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse