Provider Demographics
NPI:1447863840
Name:SELLIER, MARIAH MICHELLE (RN, BSN)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:MICHELLE
Last Name:SELLIER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 MONSERATE TER
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-9495
Mailing Address - Country:US
Mailing Address - Phone:760-822-6398
Mailing Address - Fax:
Practice Address - Street 1:5500 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1202
Practice Address - Country:US
Practice Address - Phone:760-822-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95223585163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse