Provider Demographics
NPI:1528185535
Name:WILSON, VALERIE FAYE (LPN, MX)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:FAYE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN, MX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15633 COULTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SALE CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37373-7707
Mailing Address - Country:US
Mailing Address - Phone:423-451-9927
Mailing Address - Fax:
Practice Address - Street 1:921 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2102
Practice Address - Country:US
Practice Address - Phone:423-209-8030
Practice Address - Fax:423-209-8031
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMX 0000004097247100000X
TNLPN0000057538164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse