Provider Demographics
NPI:1104355940
Name:VALBRUM, ROANN
Entity Type:Individual
Prefix:
First Name:ROANN
Middle Name:
Last Name:VALBRUM
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 1:224 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1613
Mailing Address - Country:US
Mailing Address - Phone:267-897-1328
Mailing Address - Fax:
Practice Address - Street 1:224 WABASH AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1613
Practice Address - Country:US
Practice Address - Phone:267-897-1328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA821600909OtherEMPLOYER IDENTIFICATION