Healthcare Provider Details

I. General information

NPI: 1639003486
Provider Name (Legal Business Name): VILLA AESTHETICS & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 TAYLOR DR
WATERLOO IL
62298-1152
US

IV. Provider business mailing address

906 TAYLOR DR
WATERLOO IL
62298-1152
US

V. Phone/Fax

Practice location:
  • Phone: 314-602-0752
  • Fax:
Mailing address:
  • Phone: 314-602-0752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN DRINEN
Title or Position: OWNER/ NURSE PRACTITIONER
Credential: NP-FPA
Phone: 314-602-0752