Provider Demographics
NPI:1720895550
Name:SELBY, ALISSA ROSE (NP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:ROSE
Last Name:SELBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MARKET ST W
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6428
Mailing Address - Country:US
Mailing Address - Phone:240-780-5400
Mailing Address - Fax:
Practice Address - Street 1:215 MARKET ST W
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-6428
Practice Address - Country:US
Practice Address - Phone:240-780-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR268781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily