Provider Demographics
NPI:1073881397
Name:SELSTROM, TERI L (DNP)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:L
Last Name:SELSTROM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 COOKS HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9170
Mailing Address - Country:US
Mailing Address - Phone:360-807-7776
Mailing Address - Fax:
Practice Address - Street 1:1815 COOKS HILL RD STE B
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9170
Practice Address - Country:US
Practice Address - Phone:360-807-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60229000364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health