Provider Demographics
NPI:1962573147
Name:SELLEVOLD, PATRICIA LOUISE (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:SELLEVOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CRESCENT LN
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2611
Mailing Address - Country:US
Mailing Address - Phone:607-754-4836
Mailing Address - Fax:
Practice Address - Street 1:401 CRESCENT LN
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2611
Practice Address - Country:US
Practice Address - Phone:607-754-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420284-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health