Omnia Salem – Pediatric Nurse Practitioner

Key facts

NPI: 1528440807
Entity type: Individual (NPI type 1)
Primary specialty: Pediatric Nurse Practitioner 363LP0200X
License: 2015006765 (MO)
Practice address: 6121 N Hanley Rd
Berkeley, MO 63134-2003
Phone: (314) 615-0877
NPI assigned: Jun 23, 2015
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Trusted Doctors LLC Pediatrics Physician · Fairfax, VA · NPI 1083793525

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Nurse Practitioner

State licenses

License	State	Type	Specialty
2015006765	MO	MD	Pediatric Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Trusted Doctors LLC		Past	Accepting new patients

Interoperability endpoints

Direct secure messaging: omnia.salem@ffxpeds.eclinicaldirectplus.com

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Nurse Practitioner	363LP0200X	2015006765	MO	Yes

Addresses

Primary practice location

6121 N Hanley Rd
Berkeley, MO 63134-2003

Mailing address

450 Chukker Vly
Ellisville, MO 63021-2043

Other providers in Berkeley, MO

All providers in Berkeley, MO · Pediatric Nurse Practitioner in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.