Provider Demographics
NPI:1326312489
Name:WILLSON, JANIS GAYLE (BS)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:GAYLE
Last Name:WILLSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:GAYLE
Other - Last Name:WAMPLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:812 W 8TH ST
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-7931
Mailing Address - Country:US
Mailing Address - Phone:806-288-8585
Mailing Address - Fax:806-288-8585
Practice Address - Street 1:812 W 8TH ST
Practice Address - Street 2:SUITE 9B
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7931
Practice Address - Country:US
Practice Address - Phone:806-288-8585
Practice Address - Fax:806-288-8585
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80367332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment