Provider Demographics
NPI:1336277599
Name:VALENZANO, KATHRYN E (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:VALENZANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2031
Mailing Address - Country:US
Mailing Address - Phone:856-663-1121
Mailing Address - Fax:856-661-9818
Practice Address - Street 1:124 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2031
Practice Address - Country:US
Practice Address - Phone:856-663-1121
Practice Address - Fax:856-661-9818
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00100000363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094447Medicaid
NJ096967UAWMedicare ID - Type Unspecified
NJ0094447Medicaid