MEDICARE: MRS. CATHERINE VALENCIA VILLA R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse		IL

General Provider Information

NPI Number	:	1215159918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE VALENCIA VILLA R.N.

Provider Business Mailing Address
First Line	:	445 MONTAUK LN
Second Line	:
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-9164
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4708 N CENTRAL AVE
Second Line	:	SUITE 1S
City	:	CHICAGO
State	:	IL
Zip	:	60630-3210
Country	:	US
Telephone Number	:	773-777-7815
Fax Number	:	773-777-7816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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