MEDICARE: VALERIE KIDD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704243059	MI

General Provider Information

NPI Number	:	1033805932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE KIDD

Provider Business Mailing Address
First Line	:	PO BOX 212
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48805-0212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14200 GRANDMONT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1376
Country	:	US
Telephone Number	:	313-289-4921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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Directions to “ VALERIE KIDD ” Practice Location

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