MEDICARE: COURTNEY VALENCIA VEAL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN194741	GA

General Provider Information

NPI Number	:	1902612385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY VALENCIA VEAL RN

Provider Business Mailing Address
First Line	:	6455 BEST FRIEND RD
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30071-2914
Country	:	US
Telephone Number	:	770-754-5190
Fax Number	:

Provider Business Practice Location Address
First Line	:	6455 BEST FRIEND RD
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30071-2914
Country	:	US
Telephone Number	:	770-754-5190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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