MEDICARE: MS. NOEMI VILLANUEVA STA ANA AGPCNP

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	363LP2300X	Primary Care Nurse Practitioner	309322	NY

General Provider Information

NPI Number	:	1528667169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NOEMI VILLANUEVA STA ANA AGPCNP

Provider Business Mailing Address
First Line	:	189 ROUTE 100
Second Line	:
City	:	SOMERS
State	:	NY
Zip	:	10589
Country	:	US
Telephone Number	:	914-232-5101
Fax Number	:	914-373-6497

Provider Business Practice Location Address
First Line	:	1738 NEWBRIDGE RD UNIT 1
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-1657
Country	:	US
Telephone Number	:	917-861-3374
Fax Number	:

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

Provider Enumeration Date	:	10/24/2020
Last Update Date	:	02/14/2025

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