Healthcare Provider Details

I. General information

NPI: 1790834984
Provider Name (Legal Business Name): ALEXANDRA B VILLARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WINDERMERE LN
STAMFORD CT
06902-1010
US

IV. Provider business mailing address

22 WINDERMERE LN
STAMFORD CT
06902-1010
US

V. Phone/Fax

Practice location:
  • Phone: 203-570-8406
  • Fax:
Mailing address:
  • Phone: 203-570-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number002879
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE59116
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: