Provider Demographics
NPI:1902504905
Name:GREEN, SELMA JAYNE (ARNP)
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:JAYNE
Last Name:GREEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 W CENTENNIAL PL
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3135
Mailing Address - Country:US
Mailing Address - Phone:509-954-2184
Mailing Address - Fax:
Practice Address - Street 1:2438 W CENTENNIAL PL
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3135
Practice Address - Country:US
Practice Address - Phone:509-954-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61410620363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology