Healthcare Provider Details

I. General information

NPI: 1831491513
Provider Name (Legal Business Name): VALENCIA ANN HATATHLI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 NORTH MAIN STREET
TUBA CITY AZ
86045
US

IV. Provider business mailing address

PO BOX 600
TUBA CITY AZ
86045-0600
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2629
  • Fax:
Mailing address:
  • Phone: 928-283-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License NumberRN120067
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN120067
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License NumberRN120067
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN120067
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: