MEDICARE: VIDETTE VILLAREAL- ARGENTE FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN112199	AZ
2	363LF0000X	Family Nurse Practitioner	AP3891	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033413125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIDETTE VILLAREAL- ARGENTE FNP-C

Provider Business Mailing Address
First Line	:	1300 N 12TH ST STE 407
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2842
Country	:	US
Telephone Number	:	602-839-7393
Fax Number	:	602-839-7661

Provider Business Practice Location Address
First Line	:	1300 N 12TH ST STE 407
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2842
Country	:	US
Telephone Number	:	602-839-7393
Fax Number	:	602-839-7661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	11/13/2015

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