Provider Demographics
NPI:1275102899
Name:VALENTINE, VETEMA GLORIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:VETEMA
Middle Name:GLORIA
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:VATEMA
Other - Middle Name:INNOCENCE
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1811 DALTON ST
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701
Mailing Address - Country:US
Mailing Address - Phone:865-363-4845
Mailing Address - Fax:
Practice Address - Street 1:1811 DALTON ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701
Practice Address - Country:US
Practice Address - Phone:865-363-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000058575164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse