Healthcare Provider Details

I. General information

NPI: 1629461140
Provider Name (Legal Business Name): SALINA V ANDERSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11717 BURT ST STE 203
OMAHA NE
68154-1500
US

IV. Provider business mailing address

11717 BURT ST STE 203
OMAHA NE
68154-1500
US

V. Phone/Fax

Practice location:
  • Phone: 402-302-2775
  • Fax: 833-471-4570
Mailing address:
  • Phone: 402-302-2775
  • Fax: 334-714-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number111780
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: