Provider Demographics
NPI:1124617972
Name:VILLANUEVA, DANIELLE RENEE (APRN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:RENEE
Other - Last Name:KEOMANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3220
Mailing Address - Country:US
Mailing Address - Phone:316-685-1277
Mailing Address - Fax:316-688-5208
Practice Address - Street 1:902 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3220
Practice Address - Country:US
Practice Address - Phone:316-685-1277
Practice Address - Fax:316-688-5208
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty