Provider Demographics
NPI:1851798896
Name:VILLARREAL, DIANA E (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:E
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-4647
Mailing Address - Country:US
Mailing Address - Phone:956-722-5162
Mailing Address - Fax:956-722-0676
Practice Address - Street 1:1616 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-4647
Practice Address - Country:US
Practice Address - Phone:956-722-5162
Practice Address - Fax:956-722-0676
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX789378163W00000X
TXAP126931363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care