Individual
ELIZABETH VILLAVICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACT
Contact information
Practice address
347 EDISON ST, STATEN ISLAND, NY 10306-3034
(718) 351-1136
(718) 667-9711
Mailing address
2031 FOREST AVE, STATEN ISLAND, NY 10303-1796
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F3814531
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02389417
—
NY
Enumeration date
10/03/2005
Last updated
11/09/2012
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