Healthcare Provider Details

I. General information

NPI: 1003710757
Provider Name (Legal Business Name): BRIDGETTE SELLERS RN, BSN, RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 LASSEIGNE ST
PONTIAC MI
48341-1093
US

IV. Provider business mailing address

2786 GRAVEL RIDGE DR
ROCHESTER HILLS MI
48307-4644
US

V. Phone/Fax

Practice location:
  • Phone: 989-992-4139
  • Fax: 989-573-8131
Mailing address:
  • Phone: 989-992-4139
  • Fax: 989-573-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704423125
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: