Provider Demographics
NPI:1548239692
Name:SELLERS, CATHY MARIE (FNPC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:MARIE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4238
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-9820
Mailing Address - Country:US
Mailing Address - Phone:910-641-0400
Mailing Address - Fax:910-642-5929
Practice Address - Street 1:10195 BEACH DR SW # 5
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2701
Practice Address - Country:US
Practice Address - Phone:910-641-0400
Practice Address - Fax:910-642-5929
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00395334OtherRAILROAD MEDICARE
NCP00395334OtherRAILROAD MEDICARE
NC2592058BMedicare ID - Type Unspecified