Healthcare Provider Details

I. General information

NPI: 1538546718
Provider Name (Legal Business Name): CONNIE VALLELY R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 PLUM ST
AURORA IL
60506-3462
US

IV. Provider business mailing address

1630 PLUM ST
AURORA IL
60506-3462
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-4478
  • Fax:
Mailing address:
  • Phone: 630-966-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041-282173
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: