Provider Demographics
NPI:1427355114
Name:SELBY-HELE, ROSELLA HILDEGARDE
Entity type:Individual
Prefix:
First Name:ROSELLA
Middle Name:HILDEGARDE
Last Name:SELBY-HELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15831 TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-9209
Mailing Address - Country:US
Mailing Address - Phone:763-420-8468
Mailing Address - Fax:
Practice Address - Street 1:15831 TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-9209
Practice Address - Country:US
Practice Address - Phone:763-420-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 066060-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse