Provider Demographics
NPI:1396176319
Name:LA MARCA, SELENE MARIE (AGACNP)
Entity type:Individual
Prefix:MRS
First Name:SELENE
Middle Name:MARIE
Last Name:LA MARCA
Suffix:
Gender:F
Credentials:AGACNP
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Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-998-7401
Mailing Address - Fax:505-998-7740
Practice Address - Street 1:3900 E LOHMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8268
Practice Address - Country:US
Practice Address - Phone:575-522-5752
Practice Address - Fax:575-522-5722
Is Sole Proprietor?:No
Enumeration Date:2013-12-01
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-02303363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75685248Medicaid