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General NPI Number Information
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NPI Number | 1346499241
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Entity Type | Individual
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Provider Name | MARY E WILLIS RN
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Gender | Female
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 550 POPE AVE
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-2332
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Country | US
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Telephone | 913-684-6671
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Fax |
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Provider Business Mailing Address
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Address Line | 502 3RD ST PO BOX 184
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City | WINCHESTER
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State | KS
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Zip | 66097-4152
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Country | US
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Telephone | 913-774-2024
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Fax |
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 1378828-102
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License Number State | KS
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