Provider Demographics
NPI:1659983062
Name:SELWYN, SERENA
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:SELWYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 EDGEWOOD AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5718
Mailing Address - Country:US
Mailing Address - Phone:616-469-8464
Mailing Address - Fax:
Practice Address - Street 1:2024 EDGEWOOD AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5718
Practice Address - Country:US
Practice Address - Phone:616-469-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant