Provider Demographics
NPI:1275378986
Name:DETONANCOUR, VALERIE M (RN)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:M
Last Name:DETONANCOUR
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 1:721 HOBSON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1199
Mailing Address - Country:US
Mailing Address - Phone:406-490-0918
Mailing Address - Fax:
Practice Address - Street 1:721 HOBSON AVE APT 6
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1199
Practice Address - Country:US
Practice Address - Phone:406-490-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-75134163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse