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General NPI Number Information
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NPI Number | 1467329409
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Entity Type | Individual
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Provider Name | ERIK WILLIS
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Gender | Male
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 595 DORSET ST STE 8
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6240
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Country | US
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Telephone | 802-730-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 817 VT ROUTE 15
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City | UNDERHILL
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State | VT
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Zip | 05489-9714
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Country | US
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Telephone | 802-730-5757
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 097.0135557
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License Number State | VT
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