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NPI Code Detail

MEDICARE: MRS. GEORJENA RENEE SELVA RD, LD

MEDICARE:  MRS. GEORJENA RENEE SELVA  RD, LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian756AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15Y286OTHERARMNT PROVIDER

General Provider Information

NPI Number : 1780611780
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GEORJENA RENEE SELVA RD, LD
Provider Business Mailing Address
First Line : 1620 KAVANAUGH BLVD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-4116
Country : US
Telephone Number : 501-346-7856
Fax Number :
Provider Business Practice Location Address
First Line : BAPTIST HEALTH MEDICAL CENTER-LITTLE ROCK
Second Line : 9601 INTERSTATE 630, EXIT 7
City : LITTLE ROCK
State : AR
Zip : 72205
Country : US
Telephone Number : 501-202-1889
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. GEORJENA RENEE SELVA RD, LD” Practice Location

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