Provider Demographics
NPI:1649527318
Name:VILLETTE, SENOR (NURSE (LPN))
Entity type:Individual
Prefix:
First Name:SENOR
Middle Name:
Last Name:VILLETTE
Suffix:
Gender:M
Credentials:NURSE (LPN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LEVEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-3629
Mailing Address - Country:US
Mailing Address - Phone:631-920-6517
Mailing Address - Fax:
Practice Address - Street 1:80 LEVEY BLVD
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-3629
Practice Address - Country:US
Practice Address - Phone:631-920-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289060164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse