Provider Demographics
NPI:1720792252
Name:SELVIN, DENIECE L (REGISTERED NURSE MSN)
Entity type:Individual
Prefix:
First Name:DENIECE
Middle Name:L
Last Name:SELVIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE MSN
Other - Prefix:
Other - First Name:LASANA
Other - Middle Name:D
Other - Last Name:SELVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,MSN
Mailing Address - Street 1:12277 APPLE VALLEY RD STE 228
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-1701
Mailing Address - Country:US
Mailing Address - Phone:310-429-2699
Mailing Address - Fax:
Practice Address - Street 1:12277 APPLE VALLEY RD
Practice Address - Street 2:STE 228
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-1701
Practice Address - Country:US
Practice Address - Phone:310-429-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599299163W00000X, 163WM0102X, 163WP1700X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP1700XNursing Service ProvidersRegistered NursePerinatal