Provider Demographics
NPI:1205083227
Name:VALLIANT, MARY CHRISTINE (LPN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:VALLIANT
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 1:22 CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:WOODSVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03785-1003
Mailing Address - Country:US
Mailing Address - Phone:603-747-8274
Mailing Address - Fax:
Practice Address - Street 1:22 CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:WOODSVILLE
Practice Address - State:NH
Practice Address - Zip Code:03785-1003
Practice Address - Country:US
Practice Address - Phone:603-747-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025-0008895164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse