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General NPI Number Information
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NPI Number | 1366911927
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Entity Type | Individual
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Provider Name | ANGELA SOYAD WILLIS NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 43455 SCHOENHERR RD STE 2
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-1972
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Country | US
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Telephone | 586-726-4823
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Fax |
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Provider Business Mailing Address
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Address Line | 15589 WINTERPARK DR
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City | MACOMB
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State | MI
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Zip | 48044-3877
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Country | US
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Telephone | 586-872-7866
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704307286
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License Number State | MI
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