Healthcare Provider Details

I. General information

NPI: 1902718612
Provider Name (Legal Business Name): JOSHUA SELWYN DNP, AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-8602
US

IV. Provider business mailing address

770 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-8602
US

V. Phone/Fax

Practice location:
  • Phone: 616-537-8971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704385834
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704385834
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: