Basic Information
| Provider Information | |||||||||
| NPI: | 1306071584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SELLNER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TICE | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13523 BARRETT PKWY DR | ||||||||
| Address2: | STE 210 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147752816 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 FIRST CAPITOL DRIVE | ||||||||
| Address2: | STE 210 | ||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633012844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147752816 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2009 | ||||||||
| LastUpdateDate: | 05/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2004018090 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.