Healthcare Provider Details

I. General information

NPI: 1538695952
Provider Name (Legal Business Name): JESSICA M SELLE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA M MARTIN D.O.

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E SUPERIOR ST STE 301
DULUTH MN
55802-2207
US

IV. Provider business mailing address

1001 E SUPERIOR ST STE 301
DULUTH MN
55802-2207
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-4950
  • Fax:
Mailing address:
  • Phone: 218-249-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number69421
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number69421
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: