Individual
MISS MA CORNELIA VILLAVICENCIO LEANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3081 STONE CARRIAGE CIR APT Z, FAYETTEVILLE, NC 28304
(818) 675-0386
Mailing address
3081 STONE CARRIAGE CIR APT Z, FAYETTEVILLE, NC 28304-5591
(818) 675-0386
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
LEAN-18CO92
NC
363LG0600X
Gerontology Nurse Practitioner
Primary
LEAN-18CO92
NC
Other
Enumeration date
06/25/2018
Last updated
07/11/2018
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