Provider Demographics
NPI:1225368160
Name:WILLIS, RASHUNDA RENE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:RASHUNDA
Middle Name:RENE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 LANCASHIRE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2122
Mailing Address - Country:US
Mailing Address - Phone:317-590-2335
Mailing Address - Fax:
Practice Address - Street 1:1450 LANCASHIRE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2122
Practice Address - Country:US
Practice Address - Phone:317-590-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-27
Last Update Date:2009-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27054722A164W00000X
MI4703097636164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse