Individual
LYNN G VALENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2600 W WHITE RIVER BLVD, MUNCIE, IN 47303-5263
(765) 254-5602
(765) 254-5603
Mailing address
2600 W WHITE RIVER BLVD, MUNCIE, IN 47303-5263
(765) 254-5602
(765) 254-5603
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
01030410A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378437
BC/BS #
IN
01
—
000000507764
BCBS UNDER NEW TAX ID
IN
05
—
100277960
—
IN
01
—
200839660A
MEDICAID GRP #
IN
01
—
610545900
ACS
IN
Enumeration date
12/14/2005
Last updated
06/21/2013
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