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1053836882
ALEX VILLAVICENCIO
FORT WAYNE, IN
NPI
1053836882
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: IN 71007374A)
Enumeration Date
2017-08-14
Last Update Date
2022-07-21
Business Address
ALEX VILLAVICENCIO NP-C
7601 W JEFFERSON BLVD
FORT WAYNE, IN 46804-4133
Phone number: 260-436-8686
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Mailing Address
ALEX VILLAVICENCIO NP-C
7601 W JEFFERSON BLVD
FORT WAYNE, IN 46804-4133
Phone number: 260-436-8686
Copy
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