Provider Demographics
NPI:1710209499
Name:SALEM, ELIZABETH ANN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:SALEM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:BETSY
Other - Middle Name:ANN
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11100 EUCLID AVENUE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44140
Mailing Address - Country:US
Mailing Address - Phone:216-844-3058
Mailing Address - Fax:216-844-3517
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:SUITE 380
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-3058
Practice Address - Fax:216-844-3517
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06756363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics