Provider Demographics
NPI:1609820117
Name:SELLS, MICHAEL G (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:SELLS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W BOONE AVE
Mailing Address - Street 2:SUITE 757
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2354
Mailing Address - Country:US
Mailing Address - Phone:509-868-0876
Mailing Address - Fax:509-385-0670
Practice Address - Street 1:316 W BOONE AVE
Practice Address - Street 2:SUITE 757
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2354
Practice Address - Country:US
Practice Address - Phone:509-868-0876
Practice Address - Fax:509-385-0670
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807299000Medicaid
ID807299000Medicaid
P80128Medicare UPIN