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NPI Code Detail

MEDICARE: MAGGIE WILLIS MSN APRN BC FNP PLLC

MEDICARE: MAGGIE WILLIS MSN APRN BC FNP PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner229222TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174606545
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGGIE WILLIS MSN APRN BC FNP PLLC
Provider Business Mailing Address
First Line : 243 S RIDGEOAK CT
Second Line :
City : WEATHERFORD
State : TX
Zip : 76087-6461
Country : US
Telephone Number : 214-405-0056
Fax Number :
Provider Business Practice Location Address
First Line : 206 STORRS ST
Second Line :
City : ROCKWALL
State : TX
Zip : 75087-4006
Country : US
Telephone Number : 972-772-5000
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. MAGGIE WILLIS
Credential : FNP
Telephone Number : 214-405-0056
Provider Enumeration Date : 10/22/2006
Last Update Date : 05/27/2015

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