Provider Demographics
NPI:1629461140
Name:ANDERSON, SALINA V (PMHNP)
Entity Type:Individual
Prefix:
First Name:SALINA
Middle Name:V
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 BURT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1500
Mailing Address - Country:US
Mailing Address - Phone:402-302-2775
Mailing Address - Fax:334-714-5708
Practice Address - Street 1:11717 BURT ST STE 203
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1500
Practice Address - Country:US
Practice Address - Phone:402-302-2775
Practice Address - Fax:833-471-4570
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111780363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty