Provider Demographics
NPI:1306262167
Name:VALDES, MATTHEW LUIS (APRN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LUIS
Last Name:VALDES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3909 LAPALCO BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2302
Mailing Address - Country:US
Mailing Address - Phone:504-349-6613
Mailing Address - Fax:504-349-6614
Practice Address - Street 1:3909 LAPALCO BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2302
Practice Address - Country:US
Practice Address - Phone:504-349-6613
Practice Address - Fax:504-349-6614
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP07709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily