Provider Demographics
NPI:1568507986
Name:SALEM, LINDA (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:FNP
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 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:15167 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25515-6615
Practice Address - Country:US
Practice Address - Phone:304-675-5725
Practice Address - Fax:304-675-5727
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084128Medicaid
WV3810000063Medicaid
OH0084128Medicaid