Provider Demographics
NPI:1043626161
Name:VALLE, XIOMARA (RN)
Entity type:Individual
Prefix:
First Name:XIOMARA
Middle Name:
Last Name:VALLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 METROPOLITAN AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3630
Mailing Address - Country:US
Mailing Address - Phone:917-747-9085
Mailing Address - Fax:
Practice Address - Street 1:677 METROPOLITAN AVE APT 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3630
Practice Address - Country:US
Practice Address - Phone:917-747-9085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677341-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse