Provider Demographics
NPI:1356623581
Name:VALVA, DONNA MAE (APRN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MAE
Last Name:VALVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SAYBROOK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4747
Mailing Address - Country:US
Mailing Address - Phone:860-347-4258
Mailing Address - Fax:860-704-5924
Practice Address - Street 1:420 SAYBROOK RD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4747
Practice Address - Country:US
Practice Address - Phone:860-347-4258
Practice Address - Fax:860-704-5924
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT004775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004047759Medicaid
CTD400055324 - C00023Medicare PIN
CTD400055319 - C00814Medicare PIN