Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 100621 | MO |
NPI | 1225086788 |
---|---|
Provider Name | Regina M Selva |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-4236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 13/03/2020 |