Healthcare Provider Details

I. General information

NPI: 1922804103
Provider Name (Legal Business Name): MARYBETH ANNA VALENTINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1219
US

IV. Provider business mailing address

PO BOX 973
TROY MT
59935-0973
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7800
  • Fax:
Mailing address:
  • Phone: 406-396-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberNUR-RN-LIC-178322
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number935
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: