Healthcare Provider Details

I. General information

NPI: 1124791629
Provider Name (Legal Business Name): EMMA FITZGERALD SELNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE # B065
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE # B065
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-2715
  • Fax:
Mailing address:
  • Phone: 720-777-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberDR.0077229
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6323
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: