Basic Information
| Provider Information | |||||||||
| NPI: | 1093791055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALENTA | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Credential: | A/GNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 E SKYLINE DR | ||||||||
| Address2: | 101 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857181162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206156200 | ||||||||
| FaxNumber: | 5206156255 | ||||||||
| Practice Location | |||||||||
| Address1: | 13101 N ORACLE RD | ||||||||
| Address2: | 169 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857399554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208250300 | ||||||||
| FaxNumber: | 5208250047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN051010 | AZ | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | RN051010 | AZ | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 543175 | 05 | AZ | MEDICAID |