Provider Demographics
NPI:1255100764
Name:VALKS-REID, NORDIAN THASHANA
Entity type:Individual
Prefix:
First Name:NORDIAN
Middle Name:THASHANA
Last Name:VALKS-REID
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 1:24136 NEWHALL AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2409
Mailing Address - Country:US
Mailing Address - Phone:508-737-5315
Mailing Address - Fax:
Practice Address - Street 1:24136 NEWHALL AVE FL 2
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2409
Practice Address - Country:US
Practice Address - Phone:508-737-5315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse