MEDICARE: MISS ANNE ELIZABETH VALLEY

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	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1962770792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNE ELIZABETH VALLEY

Provider Business Mailing Address
First Line	:	222 N COLUMBUS DR
Second Line	:	APT 4509
City	:	CHICAGO
State	:	IL
Zip	:	60601-7810
Country	:	US
Telephone Number	:	630-947-5173
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 N COLUMBUS DR
Second Line	:	APT 4509
City	:	CHICAGO
State	:	IL
Zip	:	60601-7810
Country	:	US
Telephone Number	:	630-947-5173
Fax Number	:

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

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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