Provider Demographics
NPI:1902824626
Name:HIVELEY BLATZ, VALERIE A (GNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:HIVELEY BLATZ
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 WEBBER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3527
Mailing Address - Country:US
Mailing Address - Phone:541-296-4804
Mailing Address - Fax:541-296-3741
Practice Address - Street 1:1015 WEBBER ST STE 100
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3527
Practice Address - Country:US
Practice Address - Phone:541-296-4804
Practice Address - Fax:541-296-3741
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088007756N4363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9624206Medicaid
OR090239Medicaid
OR500004404OtherMEDICARE RAILROAD
OR101818Medicare PIN
OR500004404Medicare PIN
WA9624206Medicaid
WAAB26706Medicare PIN