Provider Demographics
NPI:1831395516
Name:NANKIN, JESSICA MARY SELANDER (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARY SELANDER
Last Name:NANKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34709 9TH AVE S STE B500
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6789
Mailing Address - Country:US
Mailing Address - Phone:253-944-6950
Mailing Address - Fax:253-952-6824
Practice Address - Street 1:34709 9TH AVE S STE B500
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6789
Practice Address - Country:US
Practice Address - Phone:253-944-6950
Practice Address - Fax:253-952-6824
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107216207V00000X
WAMD60681538207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2069583Medicaid