Healthcare Provider Details

I. General information

NPI: 1821971904
Provider Name (Legal Business Name): MADISON SELBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR STE 130
CENTERVILLE OH
45459-4094
US

IV. Provider business mailing address

7700 WASHINGTON VILLAGE DR STE 130
CENTERVILLE OH
45459-4094
US

V. Phone/Fax

Practice location:
  • Phone: 937-531-0195
  • Fax: 937-531-0196
Mailing address:
  • Phone: 937-531-0195
  • Fax: 937-531-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0041925
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: