Provider Demographics
NPI:1518583590
Name:VILLARREAL, VIRGINIA OTEY (RN, CNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:OTEY
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:RN, CNP, FNP-BC
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:EDITH ANN
Other - Last Name:OTEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1185 TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1187
Mailing Address - Country:US
Mailing Address - Phone:651-379-1600
Mailing Address - Fax:
Practice Address - Street 1:1185 TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1187
Practice Address - Country:US
Practice Address - Phone:760-583-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2256878163W00000X
OR201500721163W00000X
MN7648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR2256878OtherMINNESOTA STATE BOARD OF NURSING
MN7648OtherMINNESOTA BOARD OF NURSING
OR201500721RNOtherOREGON STATE BOARD OF NURSING