Healthcare Provider Details

I. General information

NPI: 1033890900
Provider Name (Legal Business Name): JESSIE BRYAN VALDEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 W HIAWATHA DR
POWELL OH
43065-5107
US

IV. Provider business mailing address

39 W HIAWATHA DR
POWELL OH
43065-5107
US

V. Phone/Fax

Practice location:
  • Phone: 619-944-9227
  • Fax:
Mailing address:
  • Phone: 619-944-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number099084
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.459319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: