Healthcare Provider Details

I. General information

NPI: 1912774860
Provider Name (Legal Business Name): VALINE NNORUO DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

3435 ARCADE ST
VADNAIS HEIGHTS MN
55127-7213
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-3224
  • Fax:
Mailing address:
  • Phone: 651-734-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2886
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: