Provider Demographics
NPI:1548362767
Name:VALENA, MYRA LISA (NP)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:LISA
Last Name:VALENA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:85 RIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2210
Mailing Address - Country:US
Mailing Address - Phone:617-838-0069
Mailing Address - Fax:617-975-5207
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:KS206
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-2949
Practice Address - Fax:617-975-5207
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA237652363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0703796Medicaid