Provider Demographics
NPI:1700955481
Name:JOHN, VALSA (NP)
Entity Type:Individual
Prefix:MRS
First Name:VALSA
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8742 169TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3632
Mailing Address - Country:US
Mailing Address - Phone:718-206-2222
Mailing Address - Fax:
Practice Address - Street 1:8742 169TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3632
Practice Address - Country:US
Practice Address - Phone:718-206-2222
Practice Address - Fax:866-324-4362
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302412-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02515222Medicaid
NY02515222Medicaid
NY0493G1Medicare ID - Type Unspecified