MEDICARE: MRS. GENNA SELLERS AGPCNP-BC

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	R186601	MD
2	363LG0600X	Gerontology Nurse Practitioner	R186601	MD
3	363LP2300X	Primary Care Nurse Practitioner	R186601	MD
4	363LA2200X	Adult Health Nurse Practitioner	R186601	MD

General Provider Information

NPI Number	:	1649662776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GENNA SELLERS AGPCNP-BC

Provider Business Mailing Address
First Line	:	6190 GEORGETOWN BLVD
Second Line	:
City	:	ELDERSBURG
State	:	MD
Zip	:	21784-6460
Country	:	US
Telephone Number	:	410-552-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 WASHINGTON RD STE A
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5845
Country	:	US
Telephone Number	:	443-205-1111
Fax Number	:

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

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	05/06/2021

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