MEDICARE: ODELIA SALAZAR NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	447350	TX

General Provider Information

NPI Number	:	1134165780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODELIA SALAZAR NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	408 HIGH BROOK DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-1836
Country	:	US
Telephone Number	:	972-699-8358
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E PARK BLVD
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75074-5465
Country	:	US
Telephone Number	:	972-516-9657
Fax Number	:	972-633-0170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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