MEDICARE: MRS. SANDRA KAY VILLA R.N.

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	163WC1500X	Community Health Registered Nurse		OR

General Provider Information

NPI Number	:	1952472318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA KAY VILLA R.N.

Provider Business Mailing Address
First Line	:	3182 FOOTS CREEK R FORK RD
Second Line	:
City	:	GOLD HILL
State	:	OR
Zip	:	97525-6730
Country	:	US
Telephone Number	:	541-582-3365
Fax Number	:	541-582-8298

Provider Business Practice Location Address
First Line	:	3182 FOOTS CREEK R FORK RD
Second Line	:
City	:	GOLD HILL
State	:	OR
Zip	:	97525-6730
Country	:	US
Telephone Number	:	541-582-3365
Fax Number	:	541-582-8298

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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