Healthcare Provider Details

I. General information

NPI: 1598075038
Provider Name (Legal Business Name): EVELYN MARIE SALHANI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N COURT ST
GRAYVILLE IL
62844-1002
US

IV. Provider business mailing address

1418 COLLEGE DR
MOUNT CARMEL IL
62863-2638
US

V. Phone/Fax

Practice location:
  • Phone: 618-203-6536
  • Fax:
Mailing address:
  • Phone: 618-203-6536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.003921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: