Basic Information
Provider Information
NPI: 1316299761
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WARNER-VALENTINE
FirstName: CHRISTINE
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: VALENTINE
OtherFirstName: CHRISTINE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 4235 SECOR RD
Address2:  
City: TOLEDO
State: OH
PostalCode: 436234231
CountryCode: US
TelephoneNumber: 4194733561
FaxNumber:  
Practice Location
Address1: 4235 SECOR RD
Address2:  
City: TOLEDO
State: OH
PostalCode: 436234231
CountryCode: US
TelephoneNumber: 4194795605
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/10/2012
LastUpdateDate: 10/10/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XCOA13960NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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