Provider Demographics
NPI:1629131644
Name:VALMASSOI, BETH L (NP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:L
Last Name:VALMASSOI
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 1:32121 WOODWARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0999
Mailing Address - Country:US
Mailing Address - Phone:248-690-9946
Mailing Address - Fax:248-268-3661
Practice Address - Street 1:32121 WOODWARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0999
Practice Address - Country:US
Practice Address - Phone:248-690-9946
Practice Address - Fax:248-268-3661
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704138683363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4537169Medicaid
MI4537169Medicaid
MIO82600001Medicare ID - Type Unspecified