Provider Demographics
NPI:1437605672
Name:VALDIZNO, GLORIA (RN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:VALDIZNO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 40TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3907
Mailing Address - Country:US
Mailing Address - Phone:516-455-4459
Mailing Address - Fax:
Practice Address - Street 1:4521 40TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3907
Practice Address - Country:US
Practice Address - Phone:516-455-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY665169163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool