Provider Demographics
NPI:1033233366
Name:WILLIS, MICHAELE ANNETTE (RN)
Entity Type:Individual
Prefix:
First Name:MICHAELE
Middle Name:ANNETTE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 5TH ST
Mailing Address - Street 2:BOX 968
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-6908
Mailing Address - Country:US
Mailing Address - Phone:913-287-0007
Mailing Address - Fax:913-287-0354
Practice Address - Street 1:1301 N 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1705
Practice Address - Country:US
Practice Address - Phone:913-287-0007
Practice Address - Fax:913-287-0354
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-45391-102163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS362B673Medicare ID - Type UnspecifiedMEDICARE NUMBER