Provider Demographics
NPI:1366629172
Name:MATTHIESEN, VALERIE JEAN (NP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:MATTHIESEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UIC COLLEGE OF NURSING (MC802) 845 S. DAMEN AVENUE
Mailing Address - Street 2:ROOM 760
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-1644
Mailing Address - Fax:312-996-7725
Practice Address - Street 1:734 W 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-4411
Practice Address - Country:US
Practice Address - Phone:773-537-3960
Practice Address - Fax:773-536-2460
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003504363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health