Provider Demographics
NPI:1144794546
Name:VILLANUEVA-HERNANDEZ, YASMIN LESLIE (RN)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:LESLIE
Last Name:VILLANUEVA-HERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5937
Mailing Address - Country:US
Mailing Address - Phone:214-405-2624
Mailing Address - Fax:
Practice Address - Street 1:1305 HICKORY ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5937
Practice Address - Country:US
Practice Address - Phone:214-405-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX956093163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse