Provider Demographics
NPI:1518196153
Name:VALENTINE, NIA GAIL (NP)
Entity Type:Individual
Prefix:
First Name:NIA
Middle Name:GAIL
Last Name:VALENTINE
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 1:1 OLYMPIC PL STE 504
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4104
Mailing Address - Country:US
Mailing Address - Phone:443-501-9201
Mailing Address - Fax:
Practice Address - Street 1:200 E PRATT ST STE 4100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-6155
Practice Address - Country:US
Practice Address - Phone:443-501-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily