Provider Demographics
NPI:1144745720
Name:NEITSCH, VALERIE RENEE
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:RENEE
Last Name:NEITSCH
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 1:2416 99TH ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-5435
Mailing Address - Country:US
Mailing Address - Phone:210-508-9597
Mailing Address - Fax:
Practice Address - Street 1:5040 S COULTER ST APT 510
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-5423
Practice Address - Country:US
Practice Address - Phone:210-508-9597
Practice Address - Fax:210-508-9597
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant