Provider Demographics
NPI:1295889855
Name:SELLMAN, RENEE MARIE (QMHA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:SELLMAN
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 SE 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2514
Mailing Address - Country:US
Mailing Address - Phone:971-212-1248
Mailing Address - Fax:
Practice Address - Street 1:4101 NE DIVISION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4617
Practice Address - Country:US
Practice Address - Phone:503-666-3808
Practice Address - Fax:503-666-6835
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372600000XNursing Service Related ProvidersAdult Companion