MEDICARE: JILL R SELZLE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1258	NE

General Provider Information

NPI Number	:	1447295084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL R SELZLE PA

Provider Business Mailing Address
First Line	:	PO BOX 3755
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-0755
Country	:	US
Telephone Number	:	402-354-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 N 103RD PLZ STE 200
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-1119
Country	:	US
Telephone Number	:	402-354-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	01/03/2023

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Directions to “ JILL R SELZLE PA” Practice Location

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