Healthcare Provider Details

I. General information

NPI: 1700188190
Provider Name (Legal Business Name): MRS. ROSEMARY WILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 S WASHINGTON ST
PAPILLION NE
68046-2668
US

IV. Provider business mailing address

420 S WASHINGTON ST
PAPILLION NE
68046-2667
US

V. Phone/Fax

Practice location:
  • Phone: 402-898-0424
  • Fax:
Mailing address:
  • Phone: 402-898-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1601
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: