Provider Demographics
NPI:1013149608
Name:VILLASENOR, STELLA M
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5561
Mailing Address - Country:US
Mailing Address - Phone:309-827-0938
Mailing Address - Fax:
Practice Address - Street 1:1100 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5561
Practice Address - Country:US
Practice Address - Phone:309-827-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter