Provider Demographics
NPI:1487206967
Name:VALLES, MARIE ELISABETH MARJORIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELISABETH MARJORIE
Last Name:VALLES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2319
Mailing Address - Country:US
Mailing Address - Phone:845-426-5600
Mailing Address - Fax:
Practice Address - Street 1:661 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-2319
Practice Address - Country:US
Practice Address - Phone:845-426-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344740-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily