Individual
LAURA MARIE SELBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
37 MEYER LN, BLOOMSDALE, MO 63627-9138
(573) 483-3734
Mailing address
505 PARKVIEW DR, BLOOMSDALE, MO 63627-9136
(573) 702-8089
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
164004289
IL
133V00000X
Registered Dietitian
Primary
2015021390
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164004289
LICENSE
IL
Enumeration date
08/31/2006
Last updated
03/17/2018
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