Provider Demographics
NPI:1588482475
Name:HUIE-ROSE, SELAH TAMARA (LPN)
Entity type:Individual
Prefix:
First Name:SELAH
Middle Name:TAMARA
Last Name:HUIE-ROSE
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 1:335 BEACH 54TH ST APT 6C
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1750
Mailing Address - Country:US
Mailing Address - Phone:347-256-0549
Mailing Address - Fax:
Practice Address - Street 1:335 BEACH 54TH ST APT 6C
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1750
Practice Address - Country:US
Practice Address - Phone:347-256-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274606-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse