Basic Information
| Provider Information | |||||||||
| NPI: | 1447246038 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIPAOLO | ||||||||
| FirstName: | SELENA | ||||||||
| MiddleName: | LORRAINE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3430 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170539519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179573566 | ||||||||
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| Practice Location | |||||||||
| Address1: | 503 N 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170112204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177632100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 12/28/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | VP005264B | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | VP005264B | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1513898 | 05 | PA | MEDICAID | 50041900 | 01 | PA | CAPITAL BC | OTHER |