Provider Demographics
NPI:1043593189
Name:SELLERS, CAROLINE JOYCE (RN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:JOYCE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MARVIN AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-1169
Mailing Address - Country:US
Mailing Address - Phone:419-462-1812
Mailing Address - Fax:567-844-0066
Practice Address - Street 1:23 MARVIN AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1169
Practice Address - Country:US
Practice Address - Phone:419-462-1812
Practice Address - Fax:567-844-0066
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH373908163W00000X, 163WC0400X, 163WC2100X, 163WG0000X, 163WH0200X
OH33.007044163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)