Provider Demographics
NPI:1851473342
Name:SELLERS, DEANNA LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:SELLERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 195
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-1174
Mailing Address - Fax:612-626-0439
Practice Address - Street 1:516 DELAWARE STREET SE
Practice Address - Street 2:PWB FIRST FLOOR, CLINIC 1E
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 155742-6363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-07898OtherMEDICA CHOICE
MN1030177OtherPREFERRED ONE
MN132898OtherUCARE
MN383399200Medicaid
MNHP47449OtherHEALTH PARTNERS
MN04-04570OtherMEDICA PRIMARY
IA0598631Medicaid
MT4307494Medicaid
MNB672OtherCHAMPUS
MNP00253875Medicare ID - Type UnspecifiedRAILROAD
IA0598631Medicaid
MN132898OtherUCARE