Provider Demographics
NPI:1861878043
Name:VIRGIL, ESTELLE
Entity type:Individual
Prefix:
First Name:ESTELLE
Middle Name:
Last Name:VIRGIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESTELLE
Other - Middle Name:
Other - Last Name:VIRGIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:206 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44506-1542
Mailing Address - Country:US
Mailing Address - Phone:234-228-8068
Mailing Address - Fax:
Practice Address - Street 1:206 S PEARL ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44506-1542
Practice Address - Country:US
Practice Address - Phone:234-228-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9410722376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9410722OtherSTATE OF PA.