Provider Demographics
NPI:1982696035
Name:SELLERS, MICHAEL R (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:SELLERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8681 EAGLE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8628
Mailing Address - Country:US
Mailing Address - Phone:651-251-8021
Mailing Address - Fax:651-251-8050
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:865-342-8900
Practice Address - Fax:865-691-0843
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN472367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN221524100Medicaid
MN430004831Medicare ID - Type UnspecifiedAAPA