Healthcare Provider Details

I. General information

NPI: 1295382265
Provider Name (Legal Business Name): JANELL MARIE VILLALOBOS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 MESA BLVD.
GRANTS NM
87020
US

IV. Provider business mailing address

813 MESA BLVD.
GRANTS NM
87020
US

V. Phone/Fax

Practice location:
  • Phone: 505-879-6882
  • Fax: 800-506-4927
Mailing address:
  • Phone: 505-879-6882
  • Fax: 800-506-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR51927
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: