Provider Demographics
NPI:1992405559
Name:SALAZAR, EDNA BEATRIZ (NP)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:BEATRIZ
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3415 HOBSON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1617
Practice Address - Country:US
Practice Address - Phone:260-672-4691
Practice Address - Fax:260-458-5836
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28218127A163WX0106X
IN71013710A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health