Provider Demographics
NPI:1598243081
Name:WILLIS, ALLISON LOUISE (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:LOUISE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 HUNTINGTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6633
Mailing Address - Country:US
Mailing Address - Phone:336-745-9244
Mailing Address - Fax:
Practice Address - Street 1:2524 HUNTINGTON WOODS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6633
Practice Address - Country:US
Practice Address - Phone:336-745-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered