Provider Demographics
NPI:1063273571
Name:SALYER, MADELINE HOLM (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:HOLM
Last Name:SALYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MADELINE
Other - Middle Name:ELIZABETH
Other - Last Name:HOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MMS
Mailing Address - Street 1:860 OMNI BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4483
Mailing Address - Country:US
Mailing Address - Phone:757-504-0924
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:860 OMNI BLVD STE 113
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4430
Practice Address - Country:US
Practice Address - Phone:757-327-0657
Practice Address - Fax:757-240-5096
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110009654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant