Provider Demographics
NPI:1295203958
Name:TYSON, VALINCIA DENISE (LPN)
Entity Type:Individual
Prefix:MS
First Name:VALINCIA
Middle Name:DENISE
Last Name:TYSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2805
Mailing Address - Country:US
Mailing Address - Phone:585-683-7735
Mailing Address - Fax:
Practice Address - Street 1:100 FLINT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2805
Practice Address - Country:US
Practice Address - Phone:585-683-7735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-10
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333212164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse