Provider Demographics
NPI:1922611318
Name:MASSAQUOI, VALETTA JOHNSON (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:VALETTA
Middle Name:JOHNSON
Last Name:MASSAQUOI
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 2ND ST STE 204
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-2015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:612-567-8935
Practice Address - Street 1:464 2ND ST STE 204
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2015
Practice Address - Country:US
Practice Address - Phone:612-787-8408
Practice Address - Fax:612-567-8935
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily