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General NPI Number Information
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NPI Number | 1457417768
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Entity Type | Individual
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Provider Name | NANCY ELEANOR VILLANUEVA PHD, CRNP, BC, CNRN
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Gender | Female
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 3509 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-4105
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Country | US
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Telephone | 215-707-7200
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Fax | 215-707-3831
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Provider Business Mailing Address
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Address Line | 2450 W. HUNTING PARK AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19129
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Country | US
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Telephone | 215-707-8561
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Fax | 215-707-3677
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 85187-2
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP009551
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License Number State | PA
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