Healthcare Provider Details

I. General information

NPI: 1841285574
Provider Name (Legal Business Name): JANNA M SELLMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 HIGHWAY 62
CHARLESTOWN IN
47111-8612
US

IV. Provider business mailing address

11500 HIGHWAY 62
CHARLESTOWN IN
47111-8612
US

V. Phone/Fax

Practice location:
  • Phone: 812-256-0700
  • Fax: 812-256-0704
Mailing address:
  • Phone: 812-256-0700
  • Fax: 812-256-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01039454A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: