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General NPI Number Information
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NPI Number | 1033877642
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Entity Type | Individual
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Provider Name | PATRICIA WILLIS
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Gender | Female
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 18 MOLLISON WAY
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City | LEWISTON
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State | ME
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Zip | 04240-5811
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Country | US
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Telephone | 207-312-6860
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Fax | 207-312-6863
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Provider Business Mailing Address
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Address Line | 18 MOLLISON WAY
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City | LEWISTON
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State | ME
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Zip | 04240-5811
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Country | US
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Telephone | 207-312-6860
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Fax | 207-312-6863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RN49042
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License Number State | ME
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