Provider Demographics
NPI:1710924691
Name:VALLE, ELIZABETH J (CNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:VALLE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 ARCH ST STE 300
Mailing Address - Street 2:#300
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1473
Mailing Address - Country:US
Mailing Address - Phone:330-376-7000
Mailing Address - Fax:330-253-0853
Practice Address - Street 1:95 ARCH ST STE 300
Practice Address - Street 2:#300
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1473
Practice Address - Country:US
Practice Address - Phone:330-376-7000
Practice Address - Fax:330-253-0853
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN178090363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2621685Medicaid
NP18952Medicare PIN