Provider Demographics
NPI:1558677237
Name:ROBERTS, VALORIE J
Entity Type:Individual
Prefix:
First Name:VALORIE
Middle Name:J
Last Name:ROBERTS
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 1:10282 W FOUNTAIN AVE APT 1301
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3243
Mailing Address - Country:US
Mailing Address - Phone:608-588-1969
Mailing Address - Fax:414-446-8255
Practice Address - Street 1:10282 W FOUNTAIN AVE APT #1301
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224
Practice Address - Country:US
Practice Address - Phone:608-588-1969
Practice Address - Fax:414-446-8255
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72364-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse