Healthcare Provider Details

I. General information

NPI: 1184118697
Provider Name (Legal Business Name): SARAH PHILLIPS WILLIS RN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/03/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 HICKORY TRAIL DR
HARVEST AL
35749-7908
US

IV. Provider business mailing address

109 HICKORY TRAIL DR
HARVEST AL
35749-7908
US

V. Phone/Fax

Practice location:
  • Phone: 931-309-8118
  • Fax:
Mailing address:
  • Phone: 931-309-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1-143055
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: