Healthcare Provider Details

I. General information

NPI: 1962136481
Provider Name (Legal Business Name): VALERIE TATUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 E ILIFF AVE
AURORA CO
80014-1405
US

IV. Provider business mailing address

2357 NOME ST
AURORA CO
80010-1625
US

V. Phone/Fax

Practice location:
  • Phone: 855-891-5444
  • Fax:
Mailing address:
  • Phone: 720-616-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR.N.1647246
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: