Healthcare Provider Details

I. General information

NPI: 1861336687
Provider Name (Legal Business Name): ENA SALAK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 N 19TH AVE
PHOENIX AZ
85021-5161
US

IV. Provider business mailing address

1121 N 44TH ST APT 3098
PHOENIX AZ
85008-5743
US

V. Phone/Fax

Practice location:
  • Phone: 602-845-4505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223011
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: