Provider Demographics
NPI:1164474128
Name:VALLEY, JUANITA M (RN, MSN, ANP-C)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:M
Last Name:VALLEY
Suffix:
Gender:F
Credentials:RN, MSN, ANP-C
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:M
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, ANP-C
Mailing Address - Street 1:1034 W 800 S
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8915
Mailing Address - Country:US
Mailing Address - Phone:765-538-3099
Mailing Address - Fax:
Practice Address - Street 1:3851 N RIVER RD
Practice Address - Street 2:INDIANA VETERANS' HOME
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3762
Practice Address - Country:US
Practice Address - Phone:765-463-1502
Practice Address - Fax:765-497-8639
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN225210SOtherMEDICARE PIN/PTAN