Provider Demographics
NPI:1417256702
Name:TREESH-VALENTINE, JOHNELL J (ADULT NP, MS)
Entity type:Individual
Prefix:MS
First Name:JOHNELL
Middle Name:J
Last Name:TREESH-VALENTINE
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Gender:F
Credentials:ADULT NP, MS
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Mailing Address - Street 1:7910 W JEFFERSON BLVD
Mailing Address - Street 2:MEDICAL OFFICE BUILDING 2, SUITE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4159
Mailing Address - Country:US
Mailing Address - Phone:260-435-7433
Mailing Address - Fax:260-435-7615
Practice Address - Street 1:7910 W JEFFERSON BLVD
Practice Address - Street 2:MEDICAL OFFICE BUILDING 2, SUITE 200
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-435-7433
Practice Address - Fax:260-435-7615
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
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Provider Licenses
StateLicense IDTaxonomies
IN28137064A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health