Individual
CAROL VALDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
60101 BODNAR BLVD, SUITE B, MISHAWAKA, IN 46544-9328
(574) 335-8500
(574) 335-0794
Mailing address
707 E CEDAR ST, STE 200, SOUTH BEND, IN 46617-2057
(574) 335-8700
(574) 335-0760
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
28181527A
IN
363L00000X
Nurse Practitioner
Primary
71005360
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000919791
BCBS
IN
05
—
201281160
—
IN
Enumeration date
10/29/2014
Last updated
02/09/2017
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