Provider Demographics
NPI:1487367413
Name:VILLARS, ELIZABETH N (LPN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:N
Last Name:VILLARS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 UNION ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1622
Mailing Address - Country:US
Mailing Address - Phone:917-204-5801
Mailing Address - Fax:
Practice Address - Street 1:12 UNION ST APT 2
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1622
Practice Address - Country:US
Practice Address - Phone:917-204-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305350164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse