Provider Demographics
NPI:1760636328
Name:VALENTINE, BETH MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MARIE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 GUN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9482
Mailing Address - Country:US
Mailing Address - Phone:989-660-9775
Mailing Address - Fax:
Practice Address - Street 1:1132 GUN CLUB RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9482
Practice Address - Country:US
Practice Address - Phone:989-660-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI164W00000X164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse