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General NPI Number Information
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NPI Number | 1811050289
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Entity Type | Individual
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Provider Name | LILLIAN LIDUVINA VALLE NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1111 AMSTERDAM AVENUE ST LUKES ROOSEVELT HOSPITAL CENTER MEDICAL CLINIC
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City | NEW YORK
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State | NY
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Zip | 10025
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Country | US
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Telephone | 212-523-4415
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Fax | 212-523-4554
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Provider Business Mailing Address
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Address Line | 100 WEST 105TH STREET #D3
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City | NEW YORK
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State | NY
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Zip | 10025
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Country | US
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Telephone | 212-523-4415
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Fax | 212-523-4554
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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 | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 2834171
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F3002971
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License Number State | NY
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