Provider Demographics
NPI:1538520580
Name:SALEM, MARJORIE (FNP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N MAYFAIR RD STE 1120
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1308
Mailing Address - Country:US
Mailing Address - Phone:414-453-7780
Mailing Address - Fax:414-456-4296
Practice Address - Street 1:2600 N MAYFAIR RD STE 1120
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-453-7780
Practice Address - Fax:414-456-4296
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8994-33363L00000X
IL209014138363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner