MEDICARE: EDNA BEATRIZ SALAZAR NP

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	163WX0106X	Occupational Health Registered Nurse	28218127A	IN
2	363L00000X	Nurse Practitioner	71013710A	IN

General Provider Information

NPI Number	:	1992405559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA BEATRIZ SALAZAR NP

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 HOBSON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-1617
Country	:	US
Telephone Number	:	260-672-4691
Fax Number	:	260-458-5836

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

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	06/07/2023

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