Provider Demographics
NPI:1912524349
Name:VALENZUELA, ANDREA MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7649 MAMMOTH LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3136
Mailing Address - Country:US
Mailing Address - Phone:915-701-8409
Mailing Address - Fax:
Practice Address - Street 1:7649 MAMMOTH LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3136
Practice Address - Country:US
Practice Address - Phone:915-701-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX958454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily