Provider Demographics
NPI:1518718808
Name:SALAZAR, STEPHANIE D (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2386
Mailing Address - Country:US
Mailing Address - Phone:702-207-8263
Mailing Address - Fax:
Practice Address - Street 1:1800 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2386
Practice Address - Country:US
Practice Address - Phone:702-207-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-10-30
Deactivation Date:2024-05-29
Deactivation Code:
Reactivation Date:2024-06-18
Provider Licenses
StateLicense IDTaxonomies
NVRN91834163W00000X
NV875193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse