Provider Demographics
NPI:1033698816
Name:DEMOURA, VALERIA TANCREDO (NP)
Entity type:Individual
Prefix:MRS
First Name:VALERIA
Middle Name:TANCREDO
Last Name:DEMOURA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 RUNNING CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1362
Mailing Address - Country:US
Mailing Address - Phone:770-595-1239
Mailing Address - Fax:
Practice Address - Street 1:3191 RUNNING CEDAR DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1362
Practice Address - Country:US
Practice Address - Phone:770-595-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN211439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily