Healthcare Provider Details

I. General information

NPI: 1902504905
Provider Name (Legal Business Name): SELMA JAYNE GREEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 S HOGAN LN
SPOKANE WA
99223-8140
US

IV. Provider business mailing address

5111 S HOGAN LN
SPOKANE WA
99223-8140
US

V. Phone/Fax

Practice location:
  • Phone: 509-954-2184
  • Fax:
Mailing address:
  • Phone: 509-954-2184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61410620
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: