Individual
ROBERTA CAROL VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1270 KOT-NUM ROAD, WARM SPRINGS, OR 97761
(541) 553-1196
(541) 553-2135
Mailing address
PO BOX 1209, 1270 KOT NUM ROAD, WARM SPRINGS, OR 97761-1209
(541) 553-1196
(541) 553-2135
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
83433
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273855
—
OR
01
—
MCR HS2204
MEDICARE
—
Enumeration date
09/21/2010
Last updated
09/21/2010
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