Provider Demographics
NPI:1902226194
Name:VILLAGOMEZ-MORENO, ANA K (RN)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:K
Last Name:VILLAGOMEZ-MORENO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 BJELDE LN APT 3
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3659
Mailing Address - Country:US
Mailing Address - Phone:608-381-5723
Mailing Address - Fax:
Practice Address - Street 1:5701 BJELDE LN APT 3
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3659
Practice Address - Country:US
Practice Address - Phone:608-381-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-26
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI200138-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse