Provider Demographics
NPI:1003370602
Name:VALTER, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:VALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23380 NE VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:WOOD VILLAGE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-2858
Mailing Address - Country:US
Mailing Address - Phone:503-462-6592
Mailing Address - Fax:
Practice Address - Street 1:23380 NE VILLAGE CT
Practice Address - Street 2:
Practice Address - City:WOOD VILLAGE
Practice Address - State:OR
Practice Address - Zip Code:97060-2858
Practice Address - Country:US
Practice Address - Phone:503-462-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5006524713747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider