Provider Demographics
NPI:1699816215
Name:SALAS, JOSETTE JANINE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:JANINE
Last Name:SALAS
Suffix:
Gender:F
Credentials:CRNA
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 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:2823 FRESNO & R STREET
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1365
Practice Address - Country:US
Practice Address - Phone:559-459-6000
Practice Address - Fax:573-884-3037
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006038192367500000X
CANA95000505367500000X
CARN551345367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO775873OtherHEALTHLINK
MO914585500Medicaid
MO914585500Medicaid
MOP00400207Medicare PIN
MO833420635Medicare PIN
MOP00430581Medicare PIN
MO775873OtherHEALTHLINK