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General NPI Number Information
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NPI Number | 1376144741
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Entity Type | Individual
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Provider Name | SUHAITI LEE VILLA NP
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 25 MARSTON ST STE 301
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City | LAWRENCE
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State | MA
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Zip | 01841-2358
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Country | US
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Telephone | 978-946-8550
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Fax |
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Provider Business Mailing Address
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Address Line | 15 RIDGE ST
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City | METHUEN
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State | MA
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Zip | 01844-3122
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Country | US
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Telephone | 978-420-2599
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2277963
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN2277963
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License Number State | MA
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