Provider Demographics
NPI:1124284310
Name:SELLERS, DIANA M (LMP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:SELLERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 38TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8212
Mailing Address - Country:US
Mailing Address - Phone:253-509-4265
Mailing Address - Fax:
Practice Address - Street 1:7512 STANICH LN STE 6E
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5111
Practice Address - Country:US
Practice Address - Phone:253-509-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist