Healthcare Provider Details

I. General information

NPI: 1164852893
Provider Name (Legal Business Name): REBECCA SALOMON BA, MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 MOCKSVILLE AVE NOVANT HEALTH PSYCHIATRIC MEDICINE
SALISBURY NC
28144-2732
US

IV. Provider business mailing address

612 MOCKSVILLE AVE NOVANT HEALTH PSYCHIATRIC MEDICINE
SALISBURY NC
28144-2732
US

V. Phone/Fax

Practice location:
  • Phone: 615-397-8039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number190216
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5006598
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: