Healthcare Provider Details

I. General information

NPI: 1427462399
Provider Name (Legal Business Name): ALI R VALENTINE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42581 ROUTE 6
WYALUSING PA
18853-8542
US

IV. Provider business mailing address

42581 ROUTE 6
WYALUSING PA
18853-8542
US

V. Phone/Fax

Practice location:
  • Phone: 570-881-6215
  • Fax: 570-746-0918
Mailing address:
  • Phone: 570-881-6215
  • Fax: 570-746-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: