Provider Demographics
NPI:1528773264
Name:SELBY, CORIE LYNN
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:LYNN
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 1:100 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1344
Mailing Address - Country:US
Mailing Address - Phone:330-749-9344
Mailing Address - Fax:
Practice Address - Street 1:100 N 3RD ST
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1344
Practice Address - Country:US
Practice Address - Phone:330-749-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide