Provider Demographics
NPI:1396450466
Name:SELLERS, SUE E
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:E
Last Name:SELLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 HEMPSTEAD 148
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-1017
Mailing Address - Country:US
Mailing Address - Phone:360-305-0861
Mailing Address - Fax:
Practice Address - Street 1:316 HEMPSTEAD 148
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-1017
Practice Address - Country:US
Practice Address - Phone:360-305-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider