Healthcare Provider Details

I. General information

NPI: 1033816012
Provider Name (Legal Business Name): LISA ANN SALAMON MSN, RN, GCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST
TOMAH WI
54660-3105
US

IV. Provider business mailing address

PO BOX 226
BRIGGSVILLE WI
53920-0226
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3971
  • Fax:
Mailing address:
  • Phone: 414-238-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-105458
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: