Provider Demographics
NPI:1265617849
Name:SELKIRK FAMILY MEDICINE & WOMENS HEALTH PLLC
Entity type:Organization
Organization Name:SELKIRK FAMILY MEDICINE & WOMENS HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:DALSING
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-263-1299
Mailing Address - Street 1:1215 MICHIGAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-263-1299
Mailing Address - Fax:208-263-1557
Practice Address - Street 1:1215 MICHIGAN ST STE C
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5014
Practice Address - Country:US
Practice Address - Phone:208-263-1299
Practice Address - Fax:208-263-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP255A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1370066OtherMEDICARE GROUP PTAN
ID13417641OtherMEDICARE INDIVIDUAL PTAN
ID804142500Medicaid
ID1370066OtherMEDICARE GROUP PTAN