Provider Demographics
NPI:1881307916
Name:VILLEGAS, MARIA A (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:NUNGARAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:414-385-1922
Mailing Address - Fax:414-385-1899
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 680
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3633
Practice Address - Country:US
Practice Address - Phone:414-385-1922
Practice Address - Fax:414-385-1899
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13753363L00000X
WI193673363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100234264Medicaid