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General NPI Number Information
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NPI Number | 1437759990
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Entity Type | Individual
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Provider Name | BIANCA THERESA VILLAVASO
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 355 N CANAL ST
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City | CHICAGO
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State | IL
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Zip | 60606-0006
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Country | US
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Telephone | 877-637-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 7411 SCOTTSDALE DR
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City | NEW ORLEANS
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State | LA
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Zip | 70127-1539
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Country | US
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Telephone | 504-554-2294
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 214708
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License Number State | LA
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