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General NPI Number Information
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NPI Number | 1588322945
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Entity Type | Individual
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Provider Name | REGINA D SELLERS
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Gender | Female
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 815 57TH ST STE G
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City | KENOSHA
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State | WI
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Zip | 53140-4062
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Country | US
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Telephone | 414-326-6220
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Fax |
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Provider Business Mailing Address
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Address Line | 4721 N 74TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-4716
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Country | US
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Telephone | 414-326-6220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | WI
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