Provider Demographics
NPI:1396798427
Name:VILLENEUVE, E. JOSEPH (CRNA)
Entity type:Individual
Prefix:
First Name:E.
Middle Name:JOSEPH
Last Name:VILLENEUVE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100567
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0567
Mailing Address - Country:US
Mailing Address - Phone:843-777-4428
Mailing Address - Fax:843-777-5035
Practice Address - Street 1:301 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2509
Practice Address - Country:US
Practice Address - Phone:843-774-4111
Practice Address - Fax:843-777-5035
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN317367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0351Medicaid
SCQ27631Medicare UPIN
SC7763Medicare ID - Type UnspecifiedGROUP NUMBER