Provider Demographics
NPI:1306915590
Name:VALENTINE, DALE RICHARD (RN)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:RICHARD
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 DANBY CT
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4921
Mailing Address - Country:US
Mailing Address - Phone:770-248-8757
Mailing Address - Fax:
Practice Address - Street 1:2818 DANBY CT
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-4921
Practice Address - Country:US
Practice Address - Phone:770-248-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN075239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse