Provider Demographics
NPI:1720740657
Name:GARCIA-VAN CAMP, SELENE (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:SELENE
Middle Name:
Last Name:GARCIA-VAN CAMP
Suffix:
Gender:
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 N ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-2763
Mailing Address - Country:US
Mailing Address - Phone:580-338-7792
Mailing Address - Fax:580-338-7797
Practice Address - Street 1:1753 N ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2763
Practice Address - Country:US
Practice Address - Phone:580-338-7792
Practice Address - Fax:580-338-7797
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily