Provider Demographics
NPI:1447854468
Name:VALENZUELA, TIMOTHY A (LPN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 FLANDERS NETCONG RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9738
Mailing Address - Country:US
Mailing Address - Phone:303-324-2825
Mailing Address - Fax:
Practice Address - Street 1:179 FLANDERS NETCONG RD
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9738
Practice Address - Country:US
Practice Address - Phone:303-324-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07455500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse