Provider Demographics
NPI:1831443878
Name:TAKES, VALERIE HELEN (RN ACNP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:HELEN
Last Name:TAKES
Suffix:
Gender:F
Credentials:RN ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:DILLON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94929-0314
Mailing Address - Country:US
Mailing Address - Phone:707-217-2265
Mailing Address - Fax:
Practice Address - Street 1:501 PETALUMA AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4215
Practice Address - Country:US
Practice Address - Phone:707-271-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 22514363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care