Provider Demographics
NPI:1417699190
Name:VILLAREAL, MARILOU (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MARILOU
Middle Name:
Last Name:VILLAREAL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4909
Mailing Address - Country:US
Mailing Address - Phone:973-226-9090
Mailing Address - Fax:973-226-9093
Practice Address - Street 1:7 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-4909
Practice Address - Country:US
Practice Address - Phone:973-226-9090
Practice Address - Fax:973-226-9093
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0119000374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide