MEDICARE: CHRISTIANNE M WILLIS PA

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
1	363AM0700X	Medical Physician Assistant	1391	IA

Other Identifiers

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

General Provider Information

NPI Number	:	1326044587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANNE M WILLIS PA

Provider Business Mailing Address
First Line	:	1500 ASSOCIATES DR
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52002-2201
Country	:	US
Telephone Number	:	563-584-4100
Fax Number	:	563-584-4110

Provider Business Practice Location Address
First Line	:	117 S MADISON ST
Second Line	:
City	:	CUBA CITY
State	:	WI
Zip	:	53807-1154
Country	:	US
Telephone Number	:	608-744-2115
Fax Number	:	608-744-2117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/13/2009

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