1346372141 NPI number — MRS. PENNY JO VALESKI RN BSN

Table of content: MRS. PENNY JO VALESKI RN BSN (NPI 1346372141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346372141 NPI number — MRS. PENNY JO VALESKI RN BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALESKI
Provider First Name:
PENNY
Provider Middle Name:
JO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEACH
Provider Other First Name:
PENNY
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346372141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 85000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85754-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-770-3658
Provider Business Mailing Address Fax Number:
520-770-3787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 W SPEEDWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-770-3658
Provider Business Practice Location Address Fax Number:
520-770-3787
Provider Enumeration Date:
03/09/2007

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: 163WS0200X , with the licence number:  RN081398 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 541468 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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