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General NPI Number Information
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NPI Number | 1275831703
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Entity Type | Individual
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Provider Name | JOHN EVAN WILLIS CRNP
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Gender | Male
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 4810 WHITESPORT CIR SW SUITE 110
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City | HUNTSVILLE
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State | AL
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Zip | 35801-7419
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Country | US
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Telephone | 256-539-2531
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Fax | 256-533-0490
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Provider Business Mailing Address
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Address Line | 4810 WHITESPORT CIRCLE ALABAMA SLEEP CLINIC SUITE 110
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City | HUNTSVILLE
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State | AL
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Zip | 35801
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Country | US
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Telephone | 256-539-2531
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Fax | 256-533-0490
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-114309
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License Number State | AL
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