Provider Demographics
NPI:1992005615
Name:MOLDRE, LOURDES VILLANUEVA (RN, MSN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:VILLANUEVA
Last Name:MOLDRE
Suffix:
Gender:F
Credentials:RN, MSN, ACNP-BC
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:FERNANDEZ
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3637 MISSION AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2946
Mailing Address - Country:US
Mailing Address - Phone:916-679-3524
Mailing Address - Fax:916-488-7432
Practice Address - Street 1:3637 MISSION AVE STE 7
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2946
Practice Address - Country:US
Practice Address - Phone:916-679-3524
Practice Address - Fax:916-488-7432
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18388363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care