Provider Demographics
NPI:1134165780
Name:SALAZAR, ODELIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ODELIA
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HIGH BROOK DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1836
Mailing Address - Country:US
Mailing Address - Phone:972-699-8358
Mailing Address - Fax:
Practice Address - Street 1:900 E PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5465
Practice Address - Country:US
Practice Address - Phone:972-516-9657
Practice Address - Fax:972-633-0170
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX447350363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health