Jeremiah J Vallender, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703103784 Issued in MI

Practice address

7560 Moorish Rd
Bridgeport, MI 48722-9769

Phone

(989) 355-5944

NPI assigned

May 15, 2019

Last updated

May 15, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557878400000",
    "number": "1508422528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7560 MOORISH RD",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7560 MOORISH RD",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229769",
            "telephone_number": "989-355-5944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLENDER",
        "first_name": "JEREMIAH",
        "middle_name": "J",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-15",
        "last_updated": "2019-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703103784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Madeline Grace Way

• Licensed Practical Nurse in Bridgeport, MI
• Providers in Bridgeport, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.