Provider Demographics
NPI:1093461212
Name:VILLANUEVA-FOURNIER, JAREEZA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JAREEZA
Middle Name:
Last Name:VILLANUEVA-FOURNIER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 MACE AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7645
Mailing Address - Country:US
Mailing Address - Phone:347-612-0133
Mailing Address - Fax:
Practice Address - Street 1:102 RIVERS EDGE RD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1163
Practice Address - Country:US
Practice Address - Phone:646-672-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY676417163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health