Healthcare Provider Details

I. General information

NPI: 1174827992
Provider Name (Legal Business Name): DIANNE K SELLERS LDEM, CPM, CBE,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2011
Last Update Date: 11/04/2021
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 HEAPS RD
STREET MD
21154-1531
US

IV. Provider business mailing address

1307 HEAPS RD
STREET MD
21154-1531
US

V. Phone/Fax

Practice location:
  • Phone: 410-227-6174
  • Fax:
Mailing address:
  • Phone: 410-227-6174
  • Fax: 443-460-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: