Provider Demographics
NPI:1982328357
Name:VALENTINE, MEMUNA (RN)
Entity Type:Individual
Prefix:
First Name:MEMUNA
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33014 TRAFALGAR SQ APT 1
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4853
Mailing Address - Country:US
Mailing Address - Phone:734-353-8026
Mailing Address - Fax:
Practice Address - Street 1:33014 TRAFALGAR SQ APT 1
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4853
Practice Address - Country:US
Practice Address - Phone:734-353-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704349165163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine