Provider Demographics
NPI:1376852129
Name:SALISBURY, PAMELA WILCOX (MSN, NP-C, AOCN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:WILCOX
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:MSN, NP-C, AOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 BREAKSPEAR RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2315
Mailing Address - Country:US
Mailing Address - Phone:315-468-5021
Mailing Address - Fax:315-468-0176
Practice Address - Street 1:413 BREAKSPEAR RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-2315
Practice Address - Country:US
Practice Address - Phone:315-468-5021
Practice Address - Fax:315-468-0176
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000038363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health