MEDICARE: ROSHONDA WILLIS

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1699977645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSHONDA WILLIS

Provider Business Mailing Address
First Line	:	14405 WALTERS RD
Second Line	:	SUITE 825
City	:	HOUSTON
State	:	TX
Zip	:	77014-1337
Country	:	US
Telephone Number	:	832-484-8948
Fax Number	:	832-484-8949

Provider Business Practice Location Address
First Line	:	14405 WALTERS RD
Second Line	:	SUITE 825
City	:	HOUSTON
State	:	TX
Zip	:	77014-1337
Country	:	US
Telephone Number	:	832-484-8948
Fax Number	:	832-484-8949

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	06/02/2016

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Directions to “ ROSHONDA WILLIS ” Practice Location

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