Individual
MARTHA VILLAFANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
4600 3RD ST, MOLINE, IL 61265-6106
(309) 779-2032
Mailing address
4600 3RD ST, MOLINE, IL 61265-6106
(309) 779-2030
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2084P0800X
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1234
IOWA MEDICAID
IA
Enumeration date
09/21/2018
Last updated
09/21/2018
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