Provider Demographics
NPI:1891947917
Name:LE VALDO, PHIL;OMENA ELLEN
Entity Type:Individual
Prefix:MRS
First Name:PHIL;OMENA
Middle Name:ELLEN
Last Name:LE VALDO
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:RR 1 BOX 66
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9705
Mailing Address - Country:US
Mailing Address - Phone:406-353-3238
Mailing Address - Fax:406-353-3276
Practice Address - Street 1:RR 1 BOX 66
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9705
Practice Address - Country:US
Practice Address - Phone:406-353-3238
Practice Address - Fax:406-353-3276
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker