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NPI Code Detail

MEDICARE: WILLS INTEGRATED HEALTH LLC

MEDICARE: WILLS INTEGRATED HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner
2208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1043757107
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLS INTEGRATED HEALTH LLC
Provider Business Mailing Address
First Line : 102 MAPLE AVE
Second Line :
City : ROCHELLE
State : IL
Zip : 61068-8926
Country : US
Telephone Number : 815-562-5333
Fax Number : 815-562-5833
Provider Business Practice Location Address
First Line : 102 MAPLE AVE
Second Line :
City : ROCHELLE
State : IL
Zip : 61068-8926
Country : US
Telephone Number : 815-562-5333
Fax Number : 815-562-5833
Authorized Official
Title or Position : OWNER
Name : BRIAN WILLS
Credential :
Telephone Number : 815-562-5333
Provider Enumeration Date : 01/27/2017
Last Update Date : 01/27/2017

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Directions to “WILLS INTEGRATED HEALTH LLC ” Practice Location

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