Provider Demographics
NPI:1043280209
Name:WILLIS, DAWN CRYSTAL (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:CRYSTAL
Last Name:WILLIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 NC HWY 55
Mailing Address - Street 2:MINUTECLINIC, LLC
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-3318
Mailing Address - Country:US
Mailing Address - Phone:919-362-0381
Mailing Address - Fax:
Practice Address - Street 1:2797 NC 55 HWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6206
Practice Address - Country:US
Practice Address - Phone:919-362-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC206180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592547Medicare UPIN