Healthcare Provider Details

I. General information

NPI: 1730814468
Provider Name (Legal Business Name): MARCIA VALIQUETTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date: 08/15/2022
Reactivation Date: 12/28/2022

III. Provider practice location address

159 HONEY SUCKLE LANE
GILBOA NY
12076
US

IV. Provider business mailing address

159 HONEY SUCKLE LANE
GILBOA NY
12076
US

V. Phone/Fax

Practice location:
  • Phone: 516-329-2341
  • Fax:
Mailing address:
  • Phone: 631-339-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN37387-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: