Healthcare Provider Details

I. General information

NPI: 1841789849
Provider Name (Legal Business Name): MELISSA WILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695A BOARDMAN CANFIELD RD
CANFIELD OH
44406-9009
US

IV. Provider business mailing address

3695A BOARDMAN CANFIELD RD
CANFIELD OH
44406-9009
US

V. Phone/Fax

Practice location:
  • Phone: 330-533-3040
  • Fax: 330-533-9459
Mailing address:
  • Phone: 330-533-3040
  • Fax: 330-533-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022629
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.022629
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: