Provider Demographics
NPI:1497074744
Name:DESAMOURS, VALANCIA
Entity Type:Individual
Prefix:
First Name:VALANCIA
Middle Name:
Last Name:DESAMOURS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BONNIE CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2224
Mailing Address - Country:US
Mailing Address - Phone:845-371-1428
Mailing Address - Fax:
Practice Address - Street 1:27 BONNIE CT
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-2224
Practice Address - Country:US
Practice Address - Phone:845-371-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01000277477164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse