Provider Demographics
NPI:1043492937
Name:SELBERT, STACY MICHELE (WHNP)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:MICHELE
Last Name:SELBERT
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-2280
Mailing Address - Fax:888-352-8360
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG ONCOLOGY, STE 5F
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-2280
Practice Address - Fax:888-352-8360
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149554363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425616802Medicaid