Provider Demographics
NPI:1285634493
Name:VALENTINI, NANCY J (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:VALENTINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29751 LITTLE MACK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2238
Mailing Address - Country:US
Mailing Address - Phone:586-415-6200
Mailing Address - Fax:586-415-6217
Practice Address - Street 1:29751 LITTLE MACK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2238
Practice Address - Country:US
Practice Address - Phone:586-415-6200
Practice Address - Fax:586-415-6217
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI060859174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E061676161OtherMEDICARE PROVIDER
MI3489568Medicaid
MIF54131Medicare UPIN
MI3489568Medicaid