Provider Demographics
NPI:1275220907
Name:WILLS, DENNIS WAYNE
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:WAYNE
Last Name:WILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 LEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NIMITZ
Mailing Address - State:WV
Mailing Address - Zip Code:25978-8584
Mailing Address - Country:US
Mailing Address - Phone:304-660-8781
Mailing Address - Fax:
Practice Address - Street 1:2895 LEATHERWOOD RD
Practice Address - Street 2:
Practice Address - City:NIMITZ
Practice Address - State:WV
Practice Address - Zip Code:25978-8584
Practice Address - Country:US
Practice Address - Phone:304-660-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant