Healthcare Provider Details

I. General information

NPI: 1093821811
Provider Name (Legal Business Name): MICHEL T VILLIGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W OLD MAIN ST
YELLVILLE AR
72687-8284
US

IV. Provider business mailing address

414 W OLD MAIN ST
YELLVILLE AR
72687-8284
US

V. Phone/Fax

Practice location:
  • Phone: 870-449-4221
  • Fax: 870-449-6777
Mailing address:
  • Phone: 870-449-4221
  • Fax: 870-449-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA02937
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: