Provider Demographics
NPI:1467913780
Name:VILLEGAS, LOURDES (RN)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:VILLEGAS
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 1:393 W 49TH ST APT 2Y
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7902
Mailing Address - Country:US
Mailing Address - Phone:917-558-7655
Mailing Address - Fax:
Practice Address - Street 1:1432 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4521
Practice Address - Country:US
Practice Address - Phone:646-289-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse