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NPI Code Detail

MEDICARE: MS. MARY CHRISITNE VILELA BSW

MEDICARE: MS. MARY CHRISITNE VILELA BSW
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
1104100000XSocial Worker15430MN

General Provider Information

NPI Number : 1689884983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY CHRISITNE VILELA BSW
Provider Business Mailing Address
First Line : PO BOX 550
Second Line :
City : OSAKIS
State : MN
Zip : 56360-0550
Country : US
Telephone Number : 320-859-2271
Fax Number :
Provider Business Practice Location Address
First Line : 222 9TH AVE W
Second Line :
City : ALEXANDRIA
State : MN
Zip : 56308-2221
Country : US
Telephone Number : 320-763-3912
Fax Number : 320-763-6629
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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