Provider Demographics
NPI:1508694050
Name:VILLASENOR, MARICELA
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:
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 1:1720 INDIANOLA AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-7114
Mailing Address - Country:US
Mailing Address - Phone:206-751-6461
Mailing Address - Fax:
Practice Address - Street 1:1720 INDIANOLA AVE APT 209
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-7114
Practice Address - Country:US
Practice Address - Phone:206-751-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA338911376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide