Provider Demographics
NPI:1386317220
Name:SELLERS, VICKIE
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20609 GORDON PARK SQ STE 130
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3149
Mailing Address - Country:US
Mailing Address - Phone:571-266-0887
Mailing Address - Fax:
Practice Address - Street 1:1100 QUAKER HILL DR APT 420
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4779
Practice Address - Country:US
Practice Address - Phone:571-266-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2024-01-30
Deactivation Date:2023-07-10
Deactivation Code:
Reactivation Date:2024-01-30
Provider Licenses
StateLicense IDTaxonomies
VA121-10484246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy