Healthcare Provider Details

I. General information

NPI: 1649662776
Provider Name (Legal Business Name): GENNA SELLERS AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WASHINGTON RD STE A
WESTMINSTER MD
21157-5845
US

IV. Provider business mailing address

6190 GEORGETOWN BLVD
ELDERSBURG MD
21784-6460
US

V. Phone/Fax

Practice location:
  • Phone: 443-205-1111
  • Fax:
Mailing address:
  • Phone: 410-552-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR186601
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR186601
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR186601
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR186601
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: