Healthcare Provider Details

I. General information

NPI: 1366989634
Provider Name (Legal Business Name): NICOLA SALOMONE MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9551 SIJAN AVE
JBER AK
99506-4300
US

IV. Provider business mailing address

9551 SIJAN AVE
JBER AK
99506-4300
US

V. Phone/Fax

Practice location:
  • Phone: 907-552-6497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3021
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number188481
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: