Provider Demographics
NPI:1245329697
Name:SALAS, BARBARA R (CNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:R
Last Name:SALAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3485
Mailing Address - Country:US
Mailing Address - Phone:505-982-2991
Mailing Address - Fax:505-982-4508
Practice Address - Street 1:1424 SECOND STREET
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3485
Practice Address - Country:US
Practice Address - Phone:505-982-2991
Practice Address - Fax:505-982-4508
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR23147363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91108Medicaid
NM348228803Medicare ID - Type Unspecified
NM91108Medicaid