Provider Demographics
NPI:1063070738
Name:VALENTINE, STACEY MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 TOWNSHIP ROAD 293 SE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:OH
Mailing Address - Zip Code:43730-9757
Mailing Address - Country:US
Mailing Address - Phone:740-605-9146
Mailing Address - Fax:
Practice Address - Street 1:3535 TOWNSHIP ROAD 293 SE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:OH
Practice Address - Zip Code:43730-9757
Practice Address - Country:US
Practice Address - Phone:740-605-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily