Provider Demographics
NPI:1912978719
Name:WREDE, VALERIE JEAN
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:JEAN
Last Name:WREDE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:JEAN
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PSC 76
Mailing Address - Street 2:BOX 3914
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319
Mailing Address - Country:US
Mailing Address - Phone:317-226-6647
Mailing Address - Fax:
Practice Address - Street 1:35TH MEDICAL GROUP
Practice Address - Street 2:UNIT 5024 BLDG 99
Practice Address - City:MISAWA AIR BASE
Practice Address - State:AP
Practice Address - Zip Code:96319
Practice Address - Country:JP
Practice Address - Phone:317-226-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058917A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine