Provider Demographics
NPI:1376779546
Name:SALTER, TRACI ANN
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:ANN
Last Name:SALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PORTLAND AVENUE
Mailing Address - Street 2:MOB 445
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-3576
Mailing Address - Fax:585-922-5941
Practice Address - Street 1:1415 PORTLAND AVENUE
Practice Address - Street 2:MOB 445
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-3576
Practice Address - Fax:585-922-5941
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400050992Medicare PIN