Provider Demographics
NPI:1023352788
Name:VILLANUEVA, LESLIE V (APN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:V
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 1:389 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1218
Mailing Address - Country:US
Mailing Address - Phone:201-663-1203
Mailing Address - Fax:
Practice Address - Street 1:92 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1263
Practice Address - Country:US
Practice Address - Phone:201-342-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2600396800363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care