1073536876 NPI number — MS. DENISE C VALENTINE FNP

Table of content: MS. DENISE C VALENTINE FNP (NPI 1073536876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073536876 NPI number — MS. DENISE C VALENTINE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALENTINE
Provider First Name:
DENISE
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EKSTROM
Provider Other First Name:
DENISE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073536876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 200149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99520-0149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-561-3211
Provider Business Mailing Address Fax Number:
907-562-7547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3841 PIPER ST
Provider Second Line Business Practice Location Address:
SUITE T-100
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-4624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-561-3211
Provider Business Practice Location Address Fax Number:
907-562-7547
Provider Enumeration Date:
07/25/2006

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: 363LF0000X , with the licence number:  0050012711 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 876 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1022880 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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