Provider Demographics
NPI:1609093558
Name:WILLING, KATHLEEN P
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:WILLING
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 1:116 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097
Mailing Address - Country:US
Mailing Address - Phone:810-387-4244
Mailing Address - Fax:810-387-2605
Practice Address - Street 1:25 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097-3317
Practice Address - Country:US
Practice Address - Phone:810-387-4244
Practice Address - Fax:810-387-2605
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI080106255627233183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician