Provider Demographics
NPI:1336619675
Name:VALDAR LLC
Entity Type:Organization
Organization Name:VALDAR LLC
Other - Org Name:VALARIE JACOBS FNP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN FNP-BC
Authorized Official - Phone:801-784-8414
Mailing Address - Street 1:726 S KAYS DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-8402
Mailing Address - Country:US
Mailing Address - Phone:801-698-0544
Mailing Address - Fax:385-213-0093
Practice Address - Street 1:230 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6236
Practice Address - Country:US
Practice Address - Phone:801-698-0544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALDAR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility