Provider Demographics
NPI:1477183820
Name:SANDBERG, SELINA CORINE (CBD)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:CORINE
Last Name:SANDBERG
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N VIKING LOOP
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-0234
Mailing Address - Country:US
Mailing Address - Phone:208-217-8421
Mailing Address - Fax:
Practice Address - Street 1:1800 N VIKING LOOP
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-0234
Practice Address - Country:US
Practice Address - Phone:208-217-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty