Provider Demographics
NPI:1104562826
Name:VILLANUEVA, GWENDOLYN
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7000 HAWAII KAI DR APT 3710
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-4201
Mailing Address - Country:US
Mailing Address - Phone:808-517-1780
Mailing Address - Fax:
Practice Address - Street 1:7000 HAWAII KAI DR APT 3710
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-4201
Practice Address - Country:US
Practice Address - Phone:808-517-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide