Healthcare Provider Details

I. General information

NPI: 1790160745
Provider Name (Legal Business Name): CATHERINE FRANCES SELLERS AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 WAKE FOREST RD MOB 7, LOWER LEVEL
RALEIGH NC
27609-7340
US

IV. Provider business mailing address

3404 WAKE FOREST RD MOB 7, LOWER LEVEL
RALEIGH NC
27609-7340
US

V. Phone/Fax

Practice location:
  • Phone: 919-862-5402
  • Fax: 919-954-3191
Mailing address:
  • Phone: 919-862-5402
  • Fax: 919-954-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5007785
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: