Provider Demographics
NPI:1609034537
Name:LECORPS-VILLARREAL, MARIEFABIOLA N (LPN)
Entity Type:Individual
Prefix:
First Name:MARIEFABIOLA
Middle Name:N
Last Name:LECORPS-VILLARREAL
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 1:295 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6304
Mailing Address - Country:US
Mailing Address - Phone:212-683-0045
Mailing Address - Fax:212-725-2103
Practice Address - Street 1:85 BARTLETT STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-387-8163
Practice Address - Fax:212-531-7514
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269338164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse