Provider Demographics
NPI:1275881500
Name:SELLERS, NICOLE (LM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 MORENGO DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-5009
Mailing Address - Country:US
Mailing Address - Phone:925-408-6636
Mailing Address - Fax:
Practice Address - Street 1:2414 ASHBY AVE STE 201
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2063
Practice Address - Country:US
Practice Address - Phone:501-655-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM 122176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife