Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 0104001957 | VA |
NPI | 1023189420 |
---|---|
Provider Name | Dr. Venus A. Seleme |
First Address | Fairfax, VA 22030-2540 |
Second Address | Fairfax, VA 22030-2540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 18/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115039 | ANTHEM (01) | VA |
490746 | MEDICARE ID (01) | DC |
Y83873 | (02) | DC |