Provider Demographics
NPI:1265796502
Name:VALLES, NAOMI LOU (RN)
Entity type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:LOU
Last Name:VALLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 BONNIE ANN CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3101
Mailing Address - Country:US
Mailing Address - Phone:505-903-8924
Mailing Address - Fax:
Practice Address - Street 1:2450 ALAMO AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3204
Practice Address - Country:US
Practice Address - Phone:505-925-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-69213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse