Provider Demographics
NPI:1306856117
Name:VALACHOVICS, CHERYL R (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:VALACHOVICS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2543
Mailing Address - Country:US
Mailing Address - Phone:616-391-8635
Mailing Address - Fax:616-391-8612
Practice Address - Street 1:221 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2543
Practice Address - Country:US
Practice Address - Phone:616-391-8635
Practice Address - Fax:616-391-8612
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704177303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S89099Medicare UPIN
N99420003Medicare ID - Type Unspecified