Provider Demographics
NPI:1225414618
Name:WILLIS, CHRISTOPHER DENTON SR (CNA, GNA, CLA, CMA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DENTON
Last Name:WILLIS
Suffix:SR
Gender:M
Credentials:CNA, GNA, CLA, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 FEDERALSBURG HWY
Mailing Address - Street 2:
Mailing Address - City:FEDERALSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21632-2203
Mailing Address - Country:US
Mailing Address - Phone:410-253-1139
Mailing Address - Fax:866-451-1386
Practice Address - Street 1:4472 FEDERALSBURG HWY
Practice Address - Street 2:
Practice Address - City:FEDERALSBURG
Practice Address - State:MD
Practice Address - Zip Code:21632-2203
Practice Address - Country:US
Practice Address - Phone:410-253-1139
Practice Address - Fax:866-451-1386
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD372500000X, 372600000X, 3747P1801X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide