Healthcare Provider Details

I. General information

NPI: 1992964332
Provider Name (Legal Business Name): SHONDA L WILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 BURKHARDT AVE
AKRON OH
44301-1543
US

IV. Provider business mailing address

1012 BURKHARDT AVE
AKRON OH
44301-1543
US

V. Phone/Fax

Practice location:
  • Phone: 330-724-2616
  • Fax:
Mailing address:
  • Phone: 330-724-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: