Individual
ELIZABETH VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
2131 FOUNTAIN DR, SNELLVILLE, GA 30078-7024
(770) 979-8200
Mailing address
5115 SHADOW PATH LANE, LILBURN, GA 30047
(404) 788-1667
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R041504
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000559754D
—
GA
01
—
P00163808
RAILROAD MEDICARE
GA
Enumeration date
12/14/2005
Last updated
01/26/2010
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