Provider Demographics
NPI:1639043904
Name:VILLARUZ, ELLENJOY BASCONCILLO (BSN, RN)
Entity type:Individual
Prefix:
First Name:ELLENJOY
Middle Name:BASCONCILLO
Last Name:VILLARUZ
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:VILLARUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:3455 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3455 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3076
Practice Address - Country:US
Practice Address - Phone:253-678-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program