Provider Demographics
NPI:1265629620
Name:DONNELSON, VALERIE DALPHINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:DALPHINE
Last Name:DONNELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26067
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0067
Mailing Address - Country:US
Mailing Address - Phone:239-624-0400
Mailing Address - Fax:
Practice Address - Street 1:28410 BONITA CROSSINGS BLVD UNIT 140
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-3216
Practice Address - Country:US
Practice Address - Phone:239-624-1070
Practice Address - Fax:239-624-1071
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1172363A00000X
MO2009039324363A00000X
FLPA9116541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJVBN1OtherBCBS
FL115787900Medicaid