Provider Demographics
NPI:1427660315
Name:WILLEN, SELENA SKYE MCLEOD (APRN)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:SKYE MCLEOD
Last Name:WILLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:SKYE
Other - Last Name:MCLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE., ML 3014
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-4788
Mailing Address - Fax:513-636-4283
Practice Address - Street 1:3333 BURNET AVE., ML 3014
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4788
Practice Address - Fax:513-636-4283
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036190363L00000X
OH472778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse