Basic Information
| Provider Information | |||||||||
| NPI: | 1386830032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUMAW | ||||||||
| FirstName: | VALERIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MSN CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 W HIGH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458015914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199965033 | ||||||||
| FaxNumber: | 4199965266 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 W HIGH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458015914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199965033 | ||||||||
| FaxNumber: | 4199965266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2007 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ANPCNP09591 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | ANPCNP09591 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 3014802 | 05 | OH | MEDICAID | COA-09591NP | 01 | OH | NP | OTHER | RN-314124-COA-1 | 01 | OH | RN | OTHER |