Provider Demographics
NPI:1437759990
Name:VILLAVASO, BIANCA THERESA
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:THERESA
Last Name:VILLAVASO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 SCOTTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1539
Mailing Address - Country:US
Mailing Address - Phone:504-554-2294
Mailing Address - Fax:
Practice Address - Street 1:355 N CANAL ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-0006
Practice Address - Country:US
Practice Address - Phone:877-637-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214708363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner