Provider Demographics
NPI:1346372141
Name:VALESKI, PENNY JO (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:JO
Last Name:VALESKI
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MISS
Other - First Name:PENNY
Other - Middle Name:JO
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:PO BOX 85000
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-5000
Mailing Address - Country:US
Mailing Address - Phone:520-770-3658
Mailing Address - Fax:520-770-3787
Practice Address - Street 1:1200 W SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2326
Practice Address - Country:US
Practice Address - Phone:520-770-3658
Practice Address - Fax:520-770-3787
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN081398163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ541468Medicaid