Provider Demographics
NPI:1609491299
Name:EKSTROM, VALEENA NOEMI (RN)
Entity Type:Individual
Prefix:
First Name:VALEENA
Middle Name:NOEMI
Last Name:EKSTROM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VALEENA
Other - Middle Name:NOEMI
Other - Last Name:LEGASPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10432 STEEPLECHASE RUN LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-6929
Mailing Address - Country:US
Mailing Address - Phone:626-628-4192
Mailing Address - Fax:
Practice Address - Street 1:10432 STEEPLECHASE RUN LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-6929
Practice Address - Country:US
Practice Address - Phone:626-628-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95057748163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine