Provider Demographics
NPI:1417725862
Name:WILLIS, PATRICE LORISE
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:LORISE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31850 TUCKER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-7307
Mailing Address - Country:US
Mailing Address - Phone:830-765-1141
Mailing Address - Fax:
Practice Address - Street 1:31850 TUCKER DR
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-7307
Practice Address - Country:US
Practice Address - Phone:830-765-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care