Provider Demographics
NPI:1053462523
Name:VILLAVIEJA, MARIA ELENA (RN,FNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:VILLAVIEJA
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ELENA
Other - Last Name:DALUPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3215
Mailing Address - Country:US
Mailing Address - Phone:201-779-9075
Mailing Address - Fax:
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:NEW NURSES RESIDENCE RM 409
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333668-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner