MEDICARE: MISS SHEILA LEE VILLALOBOS LPN

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	164W00000X	Licensed Practical Nurse	LP036816	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	:	1376098350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHEILA LEE VILLALOBOS LPN

Provider Business Mailing Address
First Line	:	1700 N 103RD AVE APT 1076
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-4693
Country	:	US
Telephone Number	:	623-691-5815
Fax Number	:	623-691-5820

Provider Business Practice Location Address
First Line	:	1700 N 103RD AVE APT 1076
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-4693
Country	:	US
Telephone Number	:	623-691-5815
Fax Number	:	623-691-5820

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

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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