Provider Demographics
NPI:1518530971
Name:WILLS, DONNETTA MAXINE
Entity Type:Individual
Prefix:
First Name:DONNETTA
Middle Name:MAXINE
Last Name:WILLS
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 1:2540 ELVANS RD SE APT 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3591
Mailing Address - Country:US
Mailing Address - Phone:240-388-4841
Mailing Address - Fax:
Practice Address - Street 1:2540 ELVANS RD SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3591
Practice Address - Country:US
Practice Address - Phone:240-388-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide