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Individual
SALLY VILLASENOR
Active
Individual
SALLY VILLASENOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704210404
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10-4639777
—
MI
05
—
10-4639786
—
MI
05
—
10-4639795
—
MI
05
—
10-4639801
—
MI
05
—
11-4939782
—
MI
05
—
11-4939791
—
MI
05
—
11-4939817
—
MI
05
—
11-4939826
—
MI
Enumeration date
01/09/2006
Last updated
09/16/2020
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