Provider Demographics
NPI:1720784184
Name:BALAJADIA, QUEENNIE VILLEGAS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:QUEENNIE
Middle Name:VILLEGAS
Last Name:BALAJADIA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CADENCE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5437
Mailing Address - Country:US
Mailing Address - Phone:702-569-2904
Mailing Address - Fax:
Practice Address - Street 1:7495 W AZURE DR STE 209
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4440
Practice Address - Country:US
Practice Address - Phone:702-407-7700
Practice Address - Fax:702-407-7016
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV857650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily