Individual
MRS. SELENA JOSEPHINA GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHSC, RDN, LDN
Contact information
Practice address
5261 SHERRY LN, FAIRFIELD, OH 45014-3340
(513) 802-1184
Mailing address
5261 SHERRY LN, FAIRFIELD, OH 45014-3340
(513) 802-1184
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD.09278
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18083204
SERVSAFE
OH
01
—
215415178089
AMERICAN HEART ASSOCIATION BASIC LIFE SUPPORT
OH
01
—
86174429
DIETITIAN REGISTRATION
OH
01
—
LD.09278
DIETITIAN LICENSE
OH
Enumeration date
11/09/2021
Last updated
11/09/2021
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