Provider Demographics
NPI:1003176652
Name:SELLS, JANEE NAMEALOHA (MD)
Entity Type:Individual
Prefix:
First Name:JANEE
Middle Name:NAMEALOHA
Last Name:SELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAMEA
Other - Middle Name:
Other - Last Name:SELLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1712 S EAST BAY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6138
Mailing Address - Country:US
Mailing Address - Phone:385-375-8724
Mailing Address - Fax:
Practice Address - Street 1:3200 N CANYON RD STE C
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4682
Practice Address - Country:US
Practice Address - Phone:385-375-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-18253207Q00000X
390200000X
UT8699646-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI791831Medicaid