Provider Demographics
NPI:1427457522
Name:RODRIGUEZ, VALARI TAMARA (NP-C)
Entity type:Individual
Prefix:
First Name:VALARI
Middle Name:TAMARA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:VALARI
Other - Middle Name:TAMARA
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2130 N 73RD CT
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3106
Mailing Address - Country:US
Mailing Address - Phone:773-615-4913
Mailing Address - Fax:
Practice Address - Street 1:4711 GOLD RD
Practice Address - Street 2:1250
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-235-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041378950163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse