Healthcare Provider Details

I. General information

NPI: 1366980104
Provider Name (Legal Business Name): ELIZABETH SELZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10435 CLAYTON RD STE 110
FRONTENAC MO
63131-2930
US

IV. Provider business mailing address

10435 CLAYTON RD STE 110
FRONTENAC MO
63131-2930
US

V. Phone/Fax

Practice location:
  • Phone: 314-995-3990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013003396
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2017004781
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: