Provider Demographics
NPI:1003213430
Name:SELLNER, JACQUELINE MARIA (CNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIA
Last Name:SELLNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13609 CALIFORNIA STREET, SUITE 200
Mailing Address - Street 2:C/O AUREUS MEDICAL GROUP
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154
Mailing Address - Country:US
Mailing Address - Phone:800-856-6385
Mailing Address - Fax:
Practice Address - Street 1:13609 CALIFORNIA STREET, SUITE 200
Practice Address - Street 2:C/O AUREUS MEDICAL GROUP
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:800-856-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF1114234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily