MEDICARE: KARLA SELLERS MS, CRNP

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	363LF0000X	Family Nurse Practitioner	R090290	MD

General Provider Information

NPI Number	:	1649274143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA SELLERS MS, CRNP

Provider Business Mailing Address
First Line	:	9512 NIGHTSONG LN
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2065
Country	:	US
Telephone Number	:	301-725-6926
Fax Number	:

Provider Business Practice Location Address
First Line	:	2191 DEFENSE HWY
Second Line	:	STE 201
City	:	CROFTON
State	:	MD
Zip	:	21114-2469
Country	:	US
Telephone Number	:	410-451-9091
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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