Provider Demographics
NPI:1750604864
Name:KRIEGISCH, VALERIE MICHELLE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:MICHELLE
Last Name:KRIEGISCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 TILGHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1921
Mailing Address - Country:US
Mailing Address - Phone:410-219-5530
Mailing Address - Fax:
Practice Address - Street 1:220 TILGHMAN RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1921
Practice Address - Country:US
Practice Address - Phone:410-219-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant