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NPI Code Detail

MEDICARE: SAMANTHA JO SALOW

MEDICARE: SAMANTHA JO SALOW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician1129633IA
2207Q00000XFamily Medicine Physician1129633WI
3363LF0000XFamily Nurse Practitioner11296-33WI
4363LP2300XPrimary Care Nurse PractitionerA164679IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235808585
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA JO SALOW
Provider Business Mailing Address
First Line : 7974 UW HEALTH CT
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-5531
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3415 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-6976
Country : US
Telephone Number : 608-274-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2021
Last Update Date : 07/22/2022

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