MEDICARE: MRS. RENEE L WILLER APRN

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
1	363LF0000X	Family Nurse Practitioner	138512	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	138513	OTHER	MO	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477530814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENEE L WILLER APRN

Provider Business Mailing Address
First Line	:	4581 GRAVOIS RD
Second Line	:
City	:	HOUSE SPRINGS
State	:	MO
Zip	:	63051-1374
Country	:	US
Telephone Number	:	636-671-9980
Fax Number	:	636-671-9981

Provider Business Practice Location Address
First Line	:	4581 GRAVOIS RD
Second Line	:
City	:	HOUSE SPRINGS
State	:	MO
Zip	:	63051-1374
Country	:	US
Telephone Number	:	636-671-9980
Fax Number	:	636-671-9981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	01/29/2024

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