Basic Information
| Provider Information | |||||||||
| NPI: | 1790378446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SELLARS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | EDITH | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21283 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897211283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756714531 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 KIRMAN AVE | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895020993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757867200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2021 | ||||||||
| LastUpdateDate: | 04/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | RN63130 | NV | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | 847775 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.