Provider Demographics
NPI:1033816012
Name:SALAMON, LISA ANN (MSN, RN, GCNS-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SALAMON
Suffix:
Gender:F
Credentials:MSN, RN, GCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:BRIGGSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53920-0226
Mailing Address - Country:US
Mailing Address - Phone:414-238-4443
Mailing Address - Fax:
Practice Address - Street 1:10535 HOSPITAL WAY
Practice Address - Street 2:MAIL STOP 122/MCCL
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655
Practice Address - Country:US
Practice Address - Phone:916-843-9043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIRN-105458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse