Provider Demographics
NPI:1780698613
Name:SALAHOU, MARIAM (CRNP)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:SALAHOU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OLD ASHTON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1661
Mailing Address - Country:US
Mailing Address - Phone:215-613-5069
Mailing Address - Fax:215-613-6809
Practice Address - Street 1:16 OLD ASHTON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-1661
Practice Address - Country:US
Practice Address - Phone:215-613-5069
Practice Address - Fax:215-613-6809
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP008704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30013868OtherKEYSTONE MERCY HEALTH PLN
PA11585583OtherCAQH
PA1487927OtherAETNA
PA17574OtherBRAVO (ELDER) HEALTH
PA2848495000OtherIBC
9585583Medicare UPIN
PA096711PB0Medicare PIN
PA2848495000OtherIBC
PA30013868OtherKEYSTONE MERCY HEALTH PLN