Provider Demographics
NPI:1124782909
Name:ALTIERY, VALERIE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:ALTIERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-3949
Mailing Address - Country:US
Mailing Address - Phone:386-334-0306
Mailing Address - Fax:
Practice Address - Street 1:3030 KENNEDY ST
Practice Address - Street 2:
Practice Address - City:MIMS
Practice Address - State:FL
Practice Address - Zip Code:32754-3949
Practice Address - Country:US
Practice Address - Phone:386-334-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL863196806Medicaid