Provider Demographics
NPI:1780611780
Name:SELVA, GEORJENA RENEE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:GEORJENA
Middle Name:RENEE
Last Name:SELVA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 KAVANAUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4116
Mailing Address - Country:US
Mailing Address - Phone:501-346-7856
Mailing Address - Fax:
Practice Address - Street 1:BAPTIST HEALTH MEDICAL CENTER-LITTLE ROCK
Practice Address - Street 2:9601 INTERSTATE 630, EXIT 7
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-202-1889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR756133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y286OtherMNT PROVIDER