=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346931722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGAN SELLERS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2023
-----------------------------------------------------
Last Update Date | 05/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5454 WOLF RUN DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-378-4806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5454 WOLF RUN DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-378-4806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 470750
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
-----------------------------------------------------
License Number | 470750
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 364SR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinical Nurse Specialist
-----------------------------------------------------
License Number | 470750
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 364SA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 470750
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------