Provider Demographics
NPI:1740544717
Name:VALLE, LAURA JEANNE (APRN, CNM)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEANNE
Last Name:VALLE
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SOUTHMOOR CIR NE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2451
Mailing Address - Country:US
Mailing Address - Phone:937-829-8332
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTHMOOR CIR NE STE 2
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2407
Practice Address - Country:US
Practice Address - Phone:937-240-2100
Practice Address - Fax:937-240-2004
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0085753367A00000X
OHAPRN.CNM.019353367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife