Provider Demographics
NPI:1144528597
Name:SELBY, CHRISTINE LOU
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LOU
Last Name:SELBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11408 FLORA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2411
Mailing Address - Country:US
Mailing Address - Phone:813-374-9734
Mailing Address - Fax:
Practice Address - Street 1:11408 FLORA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2411
Practice Address - Country:US
Practice Address - Phone:801-390-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians