Provider Demographics
NPI: | 1932866233 |
---|---|
Name: | DODDS, VALERIE LYNN (CRNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | VALERIE |
Middle Name: | LYNN |
Last Name: | DODDS |
Suffix: | |
Gender: | F |
Credentials: | CRNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 824 CALIFORNIA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | AVALON |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15202-2706 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 412-766-3232 |
Mailing Address - Fax: | 412-766-4320 |
Practice Address - Street 1: | 737 BROOKSHIRE DR |
Practice Address - Street 2: | |
Practice Address - City: | HERMITAGE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16148-4507 |
Practice Address - Country: | US |
Practice Address - Phone: | 724-346-0400 |
Practice Address - Fax: | 724-346-3659 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2021-11-21 |
Last Update Date: | 2022-09-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | RN647133 | 163W00000X |
OH | APRN.CNP.0031700 | 363LF0000X |
PA | SP023979 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 163W00000X | Nursing Service Providers | Registered Nurse |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 103990970 | Medicaid | |
OH | 0497269 | Medicaid |