Healthcare Provider Details

I. General information

NPI: 1851445449
Provider Name (Legal Business Name): JUDY ANN VALLIER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RIVERVIEW AVE
WAUKESHA WI
53188-3632
US

IV. Provider business mailing address

500 RIVERVIEW AVE
WAUKESHA WI
53188-3632
US

V. Phone/Fax

Practice location:
  • Phone: 262-548-7693
  • Fax: 262-896-3375
Mailing address:
  • Phone: 262-548-7693
  • Fax: 262-896-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number43242
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: