Individual
JESSE VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 SOUTH COLLEGE STREET, SUITE 500, CHARLOTTE, NC 28202-2067
(704) 302-8800
(704) 632-4001
Mailing address
P.O.BOX 601643, CHARLOTTE, NC 28260-1643
(704) 302-8800
(704) 632-4001
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
285489
NC
363LF0000X
Family Nurse Practitioner
5008751
NC
363LF0000X
Family Nurse Practitioner
Primary
5841
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255737631
—
NC
05
—
NP4174
—
SC
Enumeration date
11/12/2014
Last updated
03/03/2017
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