Healthcare Provider Details

I. General information

NPI: 1578064119
Provider Name (Legal Business Name): DAWN ELIZABETH SELLERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 WESTFIELD BLVD
INDIANAPOLIS IN
46240-2368
US

IV. Provider business mailing address

8400 WESTFIELD BLVD
INDIANAPOLIS IN
46240-2368
US

V. Phone/Fax

Practice location:
  • Phone: 765-635-4077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: