Provider Demographics
NPI:1114901931
Name:VALDEZ, MICHELLE LEONA (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEONA
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 ADCOCK DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-8903
Mailing Address - Country:US
Mailing Address - Phone:719-589-2370
Mailing Address - Fax:719-587-0095
Practice Address - Street 1:106 BLANCA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2340
Practice Address - Country:US
Practice Address - Phone:719-589-8028
Practice Address - Fax:719-589-8086
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78188363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12050873Medicaid
COP00294181OtherMEDICARE RAILROAD CARRIER
CO12050873Medicaid
COP00294181OtherMEDICARE RAILROAD CARRIER