Provider Demographics
NPI:1750538146
Name:VILLARREAL, MARIA NINA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:NINA
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:NINA
Other - Last Name:NAGY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6415 NE CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2403
Mailing Address - Country:US
Mailing Address - Phone:503-729-6956
Mailing Address - Fax:
Practice Address - Street 1:1130 NW 22ND AVE STE 410
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2911
Practice Address - Country:US
Practice Address - Phone:503-229-7137
Practice Address - Fax:503-241-0628
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR097000288RN163W00000X
OR201050009NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse