Provider Demographics
NPI:1750962007
Name:SELLNER, MIKAELA JEAN
Entity type:Individual
Prefix:MISS
First Name:MIKAELA
Middle Name:JEAN
Last Name:SELLNER
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 1:1932 BLACK HAWK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-1652
Mailing Address - Country:US
Mailing Address - Phone:507-304-0930
Mailing Address - Fax:
Practice Address - Street 1:1932 BLACK HAWK DR
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-1652
Practice Address - Country:US
Practice Address - Phone:507-304-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer