Provider Demographics
NPI:1821690025
Name:BOMAR, VALERIE JEAN
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:BOMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7535 NATURE WAY
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-7599
Mailing Address - Country:US
Mailing Address - Phone:120-557-7077
Mailing Address - Fax:
Practice Address - Street 1:9810 ARCHER LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8914
Practice Address - Country:US
Practice Address - Phone:120-557-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2470651374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2470651Medicaid