MEDICARE: CATHY MARIE SELLERS FNPC

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	201575	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00395334	OTHER	NC	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1548239692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY MARIE SELLERS FNPC

Provider Business Mailing Address
First Line	:	PO BOX 4238
Second Line	:
City	:	CALABASH
State	:	NC
Zip	:	28467-9820
Country	:	US
Telephone Number	:	910-641-0400
Fax Number	:	910-642-5929

Provider Business Practice Location Address
First Line	:	10195 BEACH DR SW # 5
Second Line	:
City	:	CALABASH
State	:	NC
Zip	:	28467-2701
Country	:	US
Telephone Number	:	910-641-0400
Fax Number	:	910-642-5929

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	04/23/2008

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