Provider Demographics
NPI:1841355658
Name:MATHEW, VALSAMMA (WHCNP)
Entity type:Individual
Prefix:
First Name:VALSAMMA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:WHCNP
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6303 HARRY HINES BLVD STE 101
Practice Address - Street 2:MAPLE WOMEN'S HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5228
Practice Address - Country:US
Practice Address - Phone:214-266-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509993363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139699617Medicaid
TX139699625Medicaid
TX139699614Medicaid
TX139699621Medicaid
TX139699618Medicaid
TX139699622Medicaid
TX139699619Medicaid
TX139699624Medicaid
TX139699616Medicaid
TX139699623Medicaid
TX139699620Medicaid