Provider Demographics
NPI:1679932115
Name:WILLIS, CORNELIA J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CORNELIA
Middle Name:J
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 31403 BOX 13
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-1403
Mailing Address - Country:US
Mailing Address - Phone:314-636-0007
Mailing Address - Fax:
Practice Address - Street 1:VIA GIORGIO CORBETTA, 17
Practice Address - Street 2:
Practice Address - City:VICENZA
Practice Address - State:VI
Practice Address - Zip Code:36100
Practice Address - Country:IT
Practice Address - Phone:314-636-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE30523207R00000X, 208D00000X
CO0070727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice