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Individual

SELINA A JEANISE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
1333 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5435
Mailing address
12496 BELL RD, ROBY, MO 65557-8705
(936) 676-9575

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0102203214
VA
207P00000X
Emergency Medicine Physician
2015040163
MO
207P00000X
Emergency Medicine Physician
Primary
S7075
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
390200000X
GME
Enumeration date
07/07/2010
Last updated
11/05/2024
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