Provider Demographics
NPI:1619206760
Name:VILLANUEVA, WENNIE ROSE
Entity Type:Individual
Prefix:
First Name:WENNIE ROSE
Middle Name:
Last Name:VILLANUEVA
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:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-5029
Mailing Address - Fax:661-831-2605
Practice Address - Street 1:5121 STOCKDALE HWY STE 275
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2667
Practice Address - Country:US
Practice Address - Phone:661-868-5029
Practice Address - Fax:661-831-2605
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 241344164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse