MEDICARE: EVELYN MARIE SALHANI PA-C

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
1	363AM0700X	Medical Physician Assistant	085.003921	IL

General Provider Information

NPI Number	:	1598075038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN MARIE SALHANI PA-C

Provider Business Mailing Address
First Line	:	1418 COLLEGE DR
Second Line	:
City	:	MOUNT CARMEL
State	:	IL
Zip	:	62863-2638
Country	:	US
Telephone Number	:	618-203-6536
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 N COURT ST
Second Line	:
City	:	GRAYVILLE
State	:	IL
Zip	:	62844-1002
Country	:	US
Telephone Number	:	618-203-6536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	03/15/2021

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