Individual
STACEY SELLERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 BEACON ST, FORT WAYNE, IN 46805-4749
(260) 373-8000
(260) 373-8034
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
28242141C
IN
363L00000X
Nurse Practitioner
Primary
71015810A
IN
Other
Enumeration date
09/07/2024
Last updated
01/02/2025
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