Healthcare Provider Details

I. General information

NPI: 1346103181
Provider Name (Legal Business Name): LASHAWN R WILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W BROWN RD STE 3001-366
MESA AZ
85201-3221
US

IV. Provider business mailing address

560 W BROWN RD
MESA AZ
85201-3221
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-5807
  • Fax:
Mailing address:
  • Phone: 480-331-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberLICA25-22850
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: