Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 2600396800 | NJ |
NPI | 1023352788 |
---|---|
Provider Name | Leslie V Villanueva |
First Address | Lodi, NJ 07644-1218 |
Second Address | Hackensack, NJ 07601-1263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2012 |
Last Update Date | 19/11/2012 |