Provider Demographics
NPI:1972650836
Name:FLATTES, VALERIE JEAN (APRN, BC-ANP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:FLATTES
Suffix:
Gender:F
Credentials:APRN, BC-ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NPHA 4568 S HIGHLAND DRIVE
Mailing Address - Street 2:#290
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117
Mailing Address - Country:US
Mailing Address - Phone:801-274-6127
Mailing Address - Fax:801-274-6129
Practice Address - Street 1:NPHA 4568 S HIGHLAND DRIVE
Practice Address - Street 2:#290
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-274-6127
Practice Address - Fax:801-274-6129
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2872624405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ44312Medicare UPIN