Provider Demographics
NPI:1215278015
Name:VALLELY, THERESA LYNNE (RN)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNNE
Last Name:VALLELY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NY
Mailing Address - Zip Code:14883-0307
Mailing Address - Country:US
Mailing Address - Phone:607-589-7148
Mailing Address - Fax:607-589-3011
Practice Address - Street 1:16 DARTTS XRD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NY
Practice Address - Zip Code:14883-9410
Practice Address - Country:US
Practice Address - Phone:697-589-7148
Practice Address - Fax:607-589-3011
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433517-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse