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General NPI Number Information
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NPI Number | 1730638412
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Entity Type | Individual
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Provider Name | MARY VALVANO PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 109 BEE STREET RALPH H. JOHNSON VA MEDICAL CENTER,
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City | CHARLESTON
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State | SC
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Zip | 29401-5703
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Country | US
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Telephone | 843-577-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 109 BEE STREET
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City | CHARLESTON
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State | SC
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Zip | 29401-5703
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Country | US
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Telephone | 843-577-5011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 676775
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 401916
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License Number State | NY
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