Provider Demographics
NPI:1992398291
Name:VILLA, LESLIE VANESSA (RN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:VANESSA
Last Name:VILLA
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 1:10102 8TH AVE S APT G56
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5524
Mailing Address - Country:US
Mailing Address - Phone:818-857-9161
Mailing Address - Fax:
Practice Address - Street 1:2781 S 242ND ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-5166
Practice Address - Country:US
Practice Address - Phone:206-212-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61093136163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse