Healthcare Provider Details

I. General information

NPI: 1215358841
Provider Name (Legal Business Name): SELINA MARIE ROSS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2013
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E D ST
DEER PARK WA
99006-5167
US

IV. Provider business mailing address

905 E D ST
DEER PARK WA
99006-5167
US

V. Phone/Fax

Practice location:
  • Phone: 509-276-5005
  • Fax: 509-276-7067
Mailing address:
  • Phone: 509-276-5005
  • Fax: 509-276-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAP 60417500
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60417500
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: