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General NPI Number Information
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NPI Number | 1295847606
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Entity Type | Individual
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Provider Name | LAURA MARIE SELBY RDN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 37 MEYER LN
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City | BLOOMSDALE
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State | MO
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Zip | 63627-9138
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Country | US
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Telephone | 573-483-3734
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Fax |
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Provider Business Mailing Address
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Address Line | 505 PARKVIEW DR
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City | BLOOMSDALE
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State | MO
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Zip | 63627-9136
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Country | US
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Telephone | 573-702-8089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164004289
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2015021390
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License Number State | MO
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