Healthcare Provider Details

I. General information

NPI: 1326339763
Provider Name (Legal Business Name): LINDA ROSE VILLANO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 TYDD ST
EUREKA CA
95501-1284
US

IV. Provider business mailing address

670 9TH ST SUITE 203
ARCATA CA
95521-6248
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-7051
  • Fax: 707-269-7054
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number254992
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95106024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: