Provider Demographics
NPI:1558607077
Name:YEASMIN, SELINA (NP)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:YEASMIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S EUTAW ST
Mailing Address - Street 2:FRANKLINE BUILDING, 3RD FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1606
Mailing Address - Country:US
Mailing Address - Phone:410-328-3894
Mailing Address - Fax:410-328-1149
Practice Address - Street 1:16 S EUTAW ST
Practice Address - Street 2:FRANKLINE BUILDING, 3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1606
Practice Address - Country:US
Practice Address - Phone:410-328-3894
Practice Address - Fax:410-328-1149
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR158186363L00000X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care