Most Relevant Information
Provider Data
| NPI Number: | 1003561879 |
| Provider Name: | JACQUELINE M SELBURG |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/19/2022 |
| Last Updated: | 02/19/2022 |
Provider Practice Location
3878 US HWY 281 #536
BELCOURT
ND
583161248
Practice Location Phone/Fax
| Phone: | 7014720240 |
| Fax: |
Provider Mailing Location
PO BOX 1248
BELCOURT
ND
583161248
Provider Mailing Phone/Fax
| Phone: | 7014721610 |
| Fax: |