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General NPI Number Information
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NPI Number | 1962506139
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Entity Type | Individual
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Provider Name | THERESA J SELLERS RN
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Gender | Female
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 90TH N. 31ST
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City | CLINTON
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State | OK
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Zip | 73601
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Country | US
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Telephone | 580-323-6021
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Fax | 580-323-5635
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Provider Business Mailing Address
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Address Line | PO BOX 1005
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City | BURNS FLAT
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State | OK
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Zip | 73624-1005
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Country | US
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Telephone | 580-562-3204
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | R0070356
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License Number State | OK
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