Provider Demographics
NPI:1518360353
Name:SELLMER, CAROLINE BEATRICE (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BEATRICE
Last Name:SELLMER
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 BEACON ST
Mailing Address - Street 2:APT. 10
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1112
Mailing Address - Country:US
Mailing Address - Phone:562-208-6404
Mailing Address - Fax:
Practice Address - Street 1:311 BEACON ST
Practice Address - Street 2:APT. 10
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1112
Practice Address - Country:US
Practice Address - Phone:562-208-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281266363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics