Provider Demographics
NPI:1508912833
Name:SALAMEH, ELIE IBRAHIM (CRNP)
Entity Type:Individual
Prefix:MR
First Name:ELIE
Middle Name:IBRAHIM
Last Name:SALAMEH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LA RUE FRANCE
Mailing Address - Street 2:STE 201
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3104
Mailing Address - Country:US
Mailing Address - Phone:337-235-9355
Mailing Address - Fax:337-235-9356
Practice Address - Street 1:200 LA RUE FRANCE
Practice Address - Street 2:STE 201
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3104
Practice Address - Country:US
Practice Address - Phone:337-235-9355
Practice Address - Fax:337-235-9356
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR119966363LF0000X
LAAP03949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413553900Medicaid
MD306423OtherAMERIGROUP
MD896207-01OtherBCBS MD
MDQ68042Medicare UPIN
MD413553900Medicaid