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NPI Code Detail

MEDICARE: ANNETTE VALLE

MEDICARE: ANNETTE VALLE
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
1163WD0400XDiabetes Educator Registered Nurse7670848-3102UT

General Provider Information

NPI Number : 1700267069
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNETTE VALLE
Provider Business Mailing Address
First Line : 5566 S BROOKRIDGE DR APT 14V
Second Line :
City : MURRAY
State : UT
Zip : 84107-6846
Country : US
Telephone Number : 435-757-4035
Fax Number :
Provider Business Practice Location Address
First Line : 5770 S 250 E STE 310
Second Line :
City : MURRAY
State : UT
Zip : 84107-8110
Country : US
Telephone Number : 801-314-4500
Fax Number : 801-314-2909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2015
Last Update Date : 06/12/2015

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Directions to “ ANNETTE VALLE ” Practice Location

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