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General NPI Number Information
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NPI Number | 1588136840
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Entity Type | Organization
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Legal Business Name | WILLOW WOMEN AND CHILDREN'S WELLNESS, LLC
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 5665 WILSHIRE BLVD STE 1609
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City | LOS ANGELES
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State | CA
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Zip | 90036-3710
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Country | US
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Telephone | 424-600-8360
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Fax |
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Provider Business Mailing Address
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Address Line | 21358 HIGHWAY 99E NE
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City | AURORA
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State | OR
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Zip | 97002-9201
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Country | US
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Telephone | 503-678-6269
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Fax | 503-217-1599
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN CORCORAN
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Credential |
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Telephone | 503-678-6269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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