Healthcare Provider Details

I. General information

NPI: 1922240282
Provider Name (Legal Business Name): LAURA ELIZABETH SELL RUPERT PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH SELL

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W WILSON BRIDGE RD STE 200
WORTHINGTON OH
43085-2217
US

IV. Provider business mailing address

350 W WILSON BRIDGE RD STE 200
WORTHINGTON OH
43085-2217
US

V. Phone/Fax

Practice location:
  • Phone: 614-895-8747
  • Fax: 614-895-3246
Mailing address:
  • Phone: 614-895-8747
  • Fax: 614-895-3246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003263
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: