Provider Demographics
NPI:1588828024
Name:VALDIVIESO, RAQUEL (RN)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:VALDIVIESO
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 1:1525 LAUREL CROSSING PKWY
Mailing Address - Street 2:1026
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30516-6586
Mailing Address - Country:US
Mailing Address - Phone:770-544-7473
Mailing Address - Fax:
Practice Address - Street 1:1525 LAUREL CROSSING PKWY
Practice Address - Street 2:1026
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30516-6586
Practice Address - Country:US
Practice Address - Phone:770-544-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192878163WH0200X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator