Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP 60417500 | WA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP60417500 | WA |
NPI | 1215358841 |
---|---|
Provider Name | Mrs. Selina Marie Ross |
First Address | Spokane, WA 99218-1193 |
Second Address | Spokane, WA 99218-1193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2013 |
Last Update Date | 15/02/2019 |