Provider Demographics
NPI:1699403642
Name:VILLARREAL, DEYANIRA (RN)
Entity type:Individual
Prefix:
First Name:DEYANIRA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 SUTTON CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8152
Mailing Address - Country:US
Mailing Address - Phone:956-754-0530
Mailing Address - Fax:
Practice Address - Street 1:2413 SUTTON CT
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8152
Practice Address - Country:US
Practice Address - Phone:956-754-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX789377163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Single Specialty