Provider Demographics
NPI:1811497795
Name:VILLA, ANNA DOLORES
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:DOLORES
Last Name:VILLA
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 1:606 N KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-5014
Mailing Address - Country:US
Mailing Address - Phone:432-290-0583
Mailing Address - Fax:432-290-0583
Practice Address - Street 1:606 N KANSAS ST
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-5014
Practice Address - Country:US
Practice Address - Phone:432-290-0583
Practice Address - Fax:432-290-0583
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149195164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse