Provider Demographics
NPI:1376098350
Name:VILLALOBOS, SHEILA LEE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHEILA
Middle Name:LEE
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N 103RD AVE APT 1076
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4693
Mailing Address - Country:US
Mailing Address - Phone:623-691-5815
Mailing Address - Fax:623-691-5820
Practice Address - Street 1:1700 N 103RD AVE APT 1076
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4693
Practice Address - Country:US
Practice Address - Phone:623-691-5815
Practice Address - Fax:623-691-5820
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP036816164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZITINMedicaid