Provider Demographics
NPI:1912348269
Name:ROULS, VALERIE SAMMUT (PA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:SAMMUT
Last Name:ROULS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:SUZANNE
Other - Last Name:SAMMUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE HURLEY PLAZA
Mailing Address - Street 2:SON, 5TH FLOOR
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5993
Mailing Address - Country:US
Mailing Address - Phone:810-262-9353
Mailing Address - Fax:810-760-0440
Practice Address - Street 1:ONE HURLEY PLAZA
Practice Address - Street 2:7W
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5993
Practice Address - Country:US
Practice Address - Phone:810-262-9355
Practice Address - Fax:810-262-6341
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006677363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical