Healthcare Provider Details

I. General information

NPI: 1427018365
Provider Name (Legal Business Name): CHRISTINE ANNE VILLAR NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MCCALL AVE
WEST ISLIP NY
11795-3709
US

IV. Provider business mailing address

79 MIDDLEVILLE RD
NORTHPORT NY
11768-2200
US

V. Phone/Fax

Practice location:
  • Phone: 631-669-1571
  • Fax:
Mailing address:
  • Phone: 631-261-4400
  • Fax: 631-544-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number301228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: