Healthcare Provider Details

I. General information

NPI: 1003622242
Provider Name (Legal Business Name): AMY KATHLEEN SALATA MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 N YORK ST # 1010
ELMHURST IL
60126-1604
US

IV. Provider business mailing address

643 N YORK ST # 1010
ELMHURST IL
60126-1604
US

V. Phone/Fax

Practice location:
  • Phone: 708-721-2106
  • Fax:
Mailing address:
  • Phone: 708-721-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209031294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: