Provider Demographics
NPI:1043882558
Name:MALANOSKI, VALERIE DAWN
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:DAWN
Last Name:MALANOSKI
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 1:10720 JACK FLECK DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-2012
Mailing Address - Country:US
Mailing Address - Phone:915-929-3819
Mailing Address - Fax:
Practice Address - Street 1:10720 JACK FLECK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-2012
Practice Address - Country:US
Practice Address - Phone:915-929-3819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily