1063431120 NPI number — VALLERY LUCILLE MANN M.A., L. L. P.

Table of content: VALLERY LUCILLE MANN M.A., L. L. P. (NPI 1063431120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063431120 NPI number — VALLERY LUCILLE MANN M.A., L. L. P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANN
Provider First Name:
VALLERY
Provider Middle Name:
LUCILLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., L. L. P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOVEY
Provider Other First Name:
VALLERY
Provider Other Middle Name:
LUCILLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063431120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2945 16 MILE RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR SPRINGS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49319-9446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-550-7047
Provider Business Mailing Address Fax Number:
616-774-2875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
678 FRONT AVE NW
Provider Second Line Business Practice Location Address:
SUITE 265
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49504-5325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-774-2346
Provider Business Practice Location Address Fax Number:
616-774-2875
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  6301009527 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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