Healthcare Provider Details
I. General information
NPI: 1013528298
Provider Name (Legal Business Name): VALENCE HEALTH CORP PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/12/2020
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1016 W SPRUCE ST UNIT A
RAWLINS WY
82301-5371
US
IV. Provider business mailing address
PO BOX 1687
RAWLINS WY
82301-1687
US
V. Phone/Fax
- Phone: 307-328-5595
- Fax: 307-328-5561
- Phone: 702-453-3799
- Fax: 702-453-5741
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
STEPHANIE
CHIU
Title or Position: OWNER / PROVIDER
Credential: M.D.
Phone: 970-690-2577