MEDICARE: JACKIE L SELL APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	8486	WI
2	363LA2200X	Adult Health Nurse Practitioner	8486-33	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326506031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE L SELL APNP

Provider Business Mailing Address
First Line	:	1226 SCHOOL ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-4475
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 SCHOOL ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-4475
Country	:	US
Telephone Number	:	815-914-1769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	05/29/2026

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