Healthcare Provider Details

I. General information

NPI: 1700306057
Provider Name (Legal Business Name): MAUREEN SALINAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 BURR ST
SCHERERVILLE IN
46375-3402
US

IV. Provider business mailing address

8777 BROADWAY
MERRILLVILLE IN
46410-6693
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-7143
  • Fax: 219-322-6989
Mailing address:
  • Phone: 219-738-5985
  • Fax: 219-738-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007202A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: