Provider Demographics
NPI:1588315394
Name:VILLELLA, JESSICA (BBCD, BBCI)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VILLELLA
Suffix:
Gender:F
Credentials:BBCD, BBCI
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:VILLELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BIRTH ASSISTANT
Mailing Address - Street 1:2529 PORT ST
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-9478
Mailing Address - Country:US
Mailing Address - Phone:303-317-7767
Mailing Address - Fax:
Practice Address - Street 1:1817 JESSUP DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2550
Practice Address - Country:US
Practice Address - Phone:303-317-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty