MEDICARE: MARIE ELIZABETH NUNEZ VILLANUEVA APRN-CNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.006884	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041.364784	OTHER	IL	RN LICENSE
2	309.003670	OTHER	IL	APN CONTROLLED SUBSTANCE
3	32689	OTHER	CT	CONTROLLED SUBSTANCE REG.
4	209.006884	OTHER	IL	IL APN LICENSE NUMBER

General Provider Information

NPI Number	:	1457430027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE ELIZABETH NUNEZ VILLANUEVA APRN-CNP

Provider Business Mailing Address
First Line	:	446 E ONTARIO ST
Second Line	:	6TH FLOOR, SUITE 6-300
City	:	CHICAGO
State	:	IL
Zip	:	60611-4418
Country	:	US
Telephone Number	:	312-926-3207
Fax Number	:

Provider Business Practice Location Address
First Line	:	446 E ONTARIO ST
Second Line	:	6TH FLOOR, SUITE 6-300
City	:	CHICAGO
State	:	IL
Zip	:	60611-4418
Country	:	US
Telephone Number	:	312-926-3207
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	03/07/2023

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