Healthcare Provider Details

I. General information

NPI: 1649174111
Provider Name (Legal Business Name): JOHANNA VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

5102 SILVERTREE RUN APT 415
MADISON WI
53705-1476
US

V. Phone/Fax

Practice location:
  • Phone: 608-228-7254
  • Fax:
Mailing address:
  • Phone: 608-228-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number261451-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: