Provider Demographics
NPI:1720547847
Name:SELLNER, BRENDA A (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:SELLNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-5319
Mailing Address - Country:US
Mailing Address - Phone:208-507-0115
Mailing Address - Fax:
Practice Address - Street 1:332 THAIN RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5337
Practice Address - Country:US
Practice Address - Phone:208-220-1652
Practice Address - Fax:844-358-8784
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily