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General NPI Number Information
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NPI Number | 1689713745
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Entity Type | Individual
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Provider Name | DONNA J. SELLE L.AC.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 3100 N COLUMBINE AVE
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City | BOISE
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State | ID
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Zip | 83713-5053
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Country | US
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Telephone | 208-918-6724
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 N COLUMBINE AVE
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City | BOISE
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State | ID
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Zip | 83713-5053
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Country | US
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Telephone | 208-918-6724
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00003028
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00020240
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 235ACU
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License Number State | ID
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