Provider Demographics
NPI:1710091962
Name:SALMERON, BRENDA LEE (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:SALMERON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAROLINE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1806
Mailing Address - Country:US
Mailing Address - Phone:504-452-8185
Mailing Address - Fax:
Practice Address - Street 1:2005 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6320
Practice Address - Country:US
Practice Address - Phone:504-836-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN056863363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1533629Medicaid
LA5X211Medicare PIN
LAS37304Medicare UPIN