Provider Demographics
NPI:1497089387
Name:SELLS, MARK (NP-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SELLS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 HOSPITAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1929
Mailing Address - Country:US
Mailing Address - Phone:276-666-0044
Mailing Address - Fax:276-666-0393
Practice Address - Street 1:319 HOSPITAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1929
Practice Address - Country:US
Practice Address - Phone:276-666-0044
Practice Address - Fax:276-666-0393
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024169865363L00000X
CT4171363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health