Provider Demographics
NPI:1760783849
Name:WILLS, VIRGINIA E (RNC, CRNP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:WILLS
Suffix:
Gender:F
Credentials:RNC, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 THAMES ST UNIT 126
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3522
Mailing Address - Country:US
Mailing Address - Phone:347-423-8613
Mailing Address - Fax:
Practice Address - Street 1:1900 THAMES ST UNIT 126
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3522
Practice Address - Country:US
Practice Address - Phone:347-423-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR188565363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal