Healthcare Provider Details

I. General information

NPI: 1407556186
Provider Name (Legal Business Name): ASTRID K VALLENS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD
LEBANON NH
03766-1937
US

IV. Provider business mailing address

PO BOX 43
CORNISH FLAT NH
03746-0043
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-4000
  • Fax:
Mailing address:
  • Phone: 518-791-6177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number070638-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: