Healthcare Provider Details

I. General information

NPI: 1356251920
Provider Name (Legal Business Name): FERNANDA VALENCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SEMINARY AVE
AURORA IL
60505-4768
US

IV. Provider business mailing address

477 N RIVER ST
MONTGOMERY IL
60538-1319
US

V. Phone/Fax

Practice location:
  • Phone: 630-245-3749
  • Fax:
Mailing address:
  • Phone: 630-245-3749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number2677490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: