Provider Demographics
NPI:1942210315
Name:SELLERS, BONNIE LOU (RN, FNP,BC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LOU
Last Name:SELLERS
Suffix:
Gender:F
Credentials:RN, FNP,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-6260
Mailing Address - Country:US
Mailing Address - Phone:936-639-1141
Mailing Address - Fax:936-634-8601
Practice Address - Street 1:1100 OGLETREE DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-327-3786
Practice Address - Fax:936-327-1198
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXBNE524069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ65471Medicare UPIN
TX8G3893Medicare ID - Type Unspecified