Healthcare Provider Details

I. General information

NPI: 1144361585
Provider Name (Legal Business Name): DEBORAH MCCRORY WILLARD R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38251 S GROESBECK HWY
CLINTON TWP MI
48036-1929
US

IV. Provider business mailing address

28184 SAINT LOUISE DR
WARREN MI
48092-2494
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-6210
  • Fax: 586-469-7960
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704146972
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: