Provider Demographics
NPI:1710705900
Name:SELBICKY, CAROLYN (RN, BSN, CCRN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SELBICKY
Suffix:
Gender:F
Credentials:RN, BSN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 W GIBBS RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23457-1069
Mailing Address - Country:US
Mailing Address - Phone:805-748-9417
Mailing Address - Fax:
Practice Address - Street 1:2041 FISHER ARCH
Practice Address - Street 2:SUITE 140
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456
Practice Address - Country:US
Practice Address - Phone:757-650-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA799094163W00000X
VA0001283581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse