Healthcare Provider Details

I. General information

NPI: 1740338086
Provider Name (Legal Business Name): VIRGINIA VALENTINE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 PAN AMERICAN FREEWAY, NE SUITE 390
ALBUQUERQUE NM
87109-3401
US

IV. Provider business mailing address

6100 PAN AMERICAN FREEWAY, NE SUITE 390
ALBUQUERQUE NM
87109-3401
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-1805
  • Fax: 505-823-1844
Mailing address:
  • Phone: 505-823-1805
  • Fax: 505-823-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberR25515
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberCNS00087
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: