Provider Demographics
NPI:1457430027
Name:VILLANUEVA, MARIE ELIZABETH NUNEZ (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MARIE ELIZABETH
Middle Name:NUNEZ
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E ONTARIO ST
Mailing Address - Street 2:6TH FLOOR, SUITE 6-300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4418
Mailing Address - Country:US
Mailing Address - Phone:312-926-3207
Mailing Address - Fax:
Practice Address - Street 1:446 E ONTARIO ST
Practice Address - Street 2:6TH FLOOR, SUITE 6-300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4418
Practice Address - Country:US
Practice Address - Phone:312-926-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006884363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.364784OtherRN LICENSE
IL309.003670OtherAPN CONTROLLED SUBSTANCE
CT32689OtherCONTROLLED SUBSTANCE REG.
IL209.006884OtherIL APN LICENSE NUMBER
IL209.006884OtherIL APN LICENSE NUMBER
IL309.003670OtherAPN CONTROLLED SUBSTANCE
MV0319865OtherDEA
IL041.364784OtherRN LICENSE