Provider Demographics
NPI:1962553578
Name:LENGFELDER, VALERIE J (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:J
Last Name:LENGFELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:J
Other - Last Name:CORDERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2260
Mailing Address - Country:US
Mailing Address - Phone:307-754-7257
Mailing Address - Fax:307-754-1231
Practice Address - Street 1:777 AVENUE H
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2260
Practice Address - Country:US
Practice Address - Phone:307-754-7257
Practice Address - Fax:307-754-1231
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7876A207Q00000X
WAMD00043851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8425845Medicaid
WA8425845Medicaid
WAI39303Medicare UPIN