Provider Demographics
NPI:1124131552
Name:VALLONE, MARY LOUISE (ANP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:VALLONE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MCLAWS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6337
Mailing Address - Country:US
Mailing Address - Phone:757-220-8579
Mailing Address - Fax:752-345-0936
Practice Address - Street 1:ARTHRITIS & RHEUMATIC DISEASES, P.C.
Practice Address - Street 2:329 MCLAWS CIRCLE
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6337
Practice Address - Country:US
Practice Address - Phone:757-220-8579
Practice Address - Fax:757-345-0936
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301117-2363LA2200X
VA0024166821363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01570429Medicaid
R86426Medicare UPIN
NY01570429Medicaid
P00099968Medicare ID - Type UnspecifiedRR MEDICARE #