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General NPI Number Information
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NPI Number | 1033706429
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Entity Type | Individual
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Provider Name | IAN VILLANUEVA DNP, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 1900 WARDENBURG DRIVE
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City | BOULDER
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State | CO
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Zip | 80309-1508
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Country | US
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Telephone | 314-499-8625
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 17TH ST # 991
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City | DENVER
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State | CO
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Zip | 80202-1508
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Country | US
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Telephone | 314-499-8625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0996133-NP
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License Number State | CO
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