Provider Demographics
NPI:1558063156
Name:WILLIS, EMILY DAVADA
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DAVADA
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 1:800 GARFIELD AVE RM G102
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5376
Mailing Address - Country:US
Mailing Address - Phone:304-424-4575
Mailing Address - Fax:304-424-4577
Practice Address - Street 1:800 GARFIELD AVE RM G102
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5376
Practice Address - Country:US
Practice Address - Phone:304-424-4575
Practice Address - Fax:304-424-4577
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program