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General NPI Number Information
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NPI Number | 1629602081
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Entity Type | Individual
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Provider Name | PAUL DANA WILLMS FNP-C
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Gender | Male
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 635 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1935
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Country | US
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Telephone | 631-320-7503
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Fax |
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Provider Business Mailing Address
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Address Line | 1 JARRETT WHITE RD
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City | TRIPLER ARMY MEDICAL CENTER
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State | HI
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Zip | 96859-5001
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Country | US
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Telephone |
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | F344523
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F344523
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F344523
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License Number State | NY
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