Provider Demographics
NPI:1104991249
Name:SELLE, JUDITH ANNE (RN MS CNOR CRPFA)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANNE
Last Name:SELLE
Suffix:
Gender:F
Credentials:RN MS CNOR CRPFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-876-2784
Mailing Address - Fax:217-876-2785
Practice Address - Street 1:2 MEMORIAL DRIVE
Practice Address - Street 2:SUITE #207
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-876-2784
Practice Address - Fax:217-876-2785
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant