Individual ProviderJesse SelestowNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2801 W Kinnickinnic River Pkwy Ste 680, Milwaukee, WI 53215-3633(414) 385-1922(800) 326-2250PECOS EnrollmentBased on the most recent information from CMS, provider Jesse Selestow is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1780192799Provider TypeIndividualFull NameSelestow, JesseGenderFemaleSole ProprietorNoEnumeration Date1/12/2018Last Updated1/22/2024Contact InformationPractice LocationPractice Address2801 W Kinnickinnic River Pkwy Ste 680, Milwaukee, WI 53215-3633Phone(414) 385-1922FaxUnlisted FaxMailing LocationMailing AddressPO Box 735044, Chicago, IL 60673-5044Phone(800) 326-2250FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense8208-33WisconsinProvider IdentifiersIDDescriptionIssuerID100074549DescriptionMedicaidIssuerUnlistedWisconsin