Provider Demographics
NPI:1174749154
Name:ANDRADA, LILIBETH VILLANUEVA (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:LILIBETH
Middle Name:VILLANUEVA
Last Name:ANDRADA
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 RHEIN CT
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1030
Mailing Address - Country:US
Mailing Address - Phone:201-384-8564
Mailing Address - Fax:
Practice Address - Street 1:597 RHEIN CT
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1030
Practice Address - Country:US
Practice Address - Phone:201-384-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF 381370-1363LP0200X
NY4212561163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics