Provider Demographics
NPI:1750827184
Name:VILLAGRANA, ELIZABETH (LPN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VILLAGRANA
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 1:32753 E DELANEY ST
Mailing Address - Street 2:
Mailing Address - City:COBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9265
Mailing Address - Country:US
Mailing Address - Phone:541-514-7366
Mailing Address - Fax:
Practice Address - Street 1:32753 E DELANEY ST
Practice Address - Street 2:
Practice Address - City:COBURG
Practice Address - State:OR
Practice Address - Zip Code:97408-9265
Practice Address - Country:US
Practice Address - Phone:541-514-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200630289LPN261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health