Provider Demographics
NPI:1235136086
Name:SALEM, BARBARA M (FNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:M
Last Name:SALEM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:M
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:810 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-8201
Practice Address - Country:US
Practice Address - Phone:574-583-6543
Practice Address - Fax:574-583-9502
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332704363LF0000X
IN71002753A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000782284OtherANTHEM PROVIDER NUMBER
NY02328527Medicaid
IN200913330Medicaid
IN200301560GMedicaid
IN100187080Medicaid
IN000000782284OtherANTHEM PROVIDER NUMBER
IN100187080Medicaid
IN200301560GMedicaid
NY02328527Medicaid