Healthcare Provider Details

I. General information

NPI: 1497877286
Provider Name (Legal Business Name): MICHELLE JEAN VALENTINE RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 OLD CEDAR AVE S
BLOOMINGTON MN
55425-1207
US

IV. Provider business mailing address

7920 OLD CEDAR AVE S
BLOOMINGTON MN
55425-1207
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-1800
  • Fax:
Mailing address:
  • Phone: 952-428-1800
  • Fax: 952-428-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberVAL1-0430-2174
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1252
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: