Provider Demographics
NPI:1629571898
Name:WILLIS, JOYCE MAXINE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:MAXINE
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 1:724 RIDER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-4695
Mailing Address - Country:US
Mailing Address - Phone:720-635-2692
Mailing Address - Fax:
Practice Address - Street 1:2800 DAGNY WAY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8011
Practice Address - Country:US
Practice Address - Phone:720-635-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator