Provider Demographics
NPI:1427321306
Name:SELLE, JENNIFER R (RNC CADC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
Last Name:SELLE
Suffix:
Gender:F
Credentials:RNC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37444 N DELANY RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3525
Mailing Address - Country:US
Mailing Address - Phone:847-249-4776
Mailing Address - Fax:847-249-7497
Practice Address - Street 1:37444 N DELANY RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3525
Practice Address - Country:US
Practice Address - Phone:847-249-4776
Practice Address - Fax:847-249-7497
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0041-213915163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse