MEDICARE: GUADALUPE VILLAVICENCIO

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	3747P1801X	Personal Care Attendant		NE
2	372600000X	Adult Companion		NE

General Provider Information

NPI Number	:	1790644631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUADALUPE VILLAVICENCIO

Provider Business Mailing Address
First Line	:	924 S KIMBALL ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-7920
Country	:	US
Telephone Number	:	308-383-4402
Fax Number	:

Provider Business Practice Location Address
First Line	:	924 S KIMBALL ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-7920
Country	:	US
Telephone Number	:	308-383-4402
Fax Number	:

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

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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Directions to “ GUADALUPE VILLAVICENCIO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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