Provider Demographics
NPI:1245430313
Name:WILLIS, MARILYN ELIZABETH (CRNFA)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:WILLIS
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 PINE TRAIL
Mailing Address - Street 2:
Mailing Address - City:ALPINE MEADOWS
Mailing Address - State:CA
Mailing Address - Zip Code:96146
Mailing Address - Country:US
Mailing Address - Phone:530-550-2940
Mailing Address - Fax:530-550-7315
Practice Address - Street 1:10770 DONNER PASS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4880
Practice Address - Country:US
Practice Address - Phone:530-550-2940
Practice Address - Fax:530-550-7315
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253021163W00000X
CA081500163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse