Healthcare Provider Details

I. General information

NPI: 1619106374
Provider Name (Legal Business Name): DEBORAH CHARLENE WILLIS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH CHARLENE SASSANIAN RRT

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 MARY ELIZABETH CHURCH RD
WAXHAW NC
28173-9273
US

IV. Provider business mailing address

3608 MARY ELIZABETH CHURCH RD
WAXHAW NC
28173-9273
US

V. Phone/Fax

Practice location:
  • Phone: 704-534-0596
  • Fax: 704-243-6119
Mailing address:
  • Phone: 704-534-0596
  • Fax: 704-534-0596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberA-799
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: