Individual
MAYOLA LARA VILLARRUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
901 MACARTHUR BLVD, MUNSTER, IN 46321-2901
(219) 513-1109
Mailing address
10040 CLARK PL, CROWN POINT, IN 46307-2782
(219) 616-4546
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
28069615A
IN
Other
Enumeration date
06/11/2013
Last updated
06/11/2013
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