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NPI Code Detail

MEDICARE: MR. WILLARD EDWARD VALENTINE PA-C

MEDICARE: MR. WILLARD EDWARD VALENTINE PA-C
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
1363A00000XPhysician Assistant0101298NC

General Provider Information

NPI Number : 1417041492
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLARD EDWARD VALENTINE PA-C
Provider Business Mailing Address
First Line : 480 RUIN CREEK RD
Second Line :
City : HENDERSON
State : NC
Zip : 27536-2929
Country : US
Telephone Number : 252-492-3152
Fax Number : 252-430-1928
Provider Business Practice Location Address
First Line : 480 RUIN CREEK RD
Second Line :
City : HENDERSON
State : NC
Zip : 27536-2929
Country : US
Telephone Number : 252-492-3152
Fax Number : 252-430-1928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/08/2007

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