Provider Demographics
NPI:1881849065
Name:VILLANUEVA, AMARILIS (APN)
Entity Type:Individual
Prefix:MRS
First Name:AMARILIS
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-8540
Mailing Address - Country:US
Mailing Address - Phone:973-458-8000
Mailing Address - Fax:973-458-8425
Practice Address - Street 1:913 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-8540
Practice Address - Country:US
Practice Address - Phone:973-458-8000
Practice Address - Fax:973-458-8425
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR07111600163WR0400X
NJ26NJ00899000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation