Provider Demographics
NPI:1790241883
Name:WILLETT, ADDYE (LVN)
Entity Type:Individual
Prefix:
First Name:ADDYE
Middle Name:
Last Name:WILLETT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:POLLOK
Mailing Address - State:TX
Mailing Address - Zip Code:75969-3223
Mailing Address - Country:US
Mailing Address - Phone:936-635-6649
Mailing Address - Fax:
Practice Address - Street 1:561 MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:POLLOK
Practice Address - State:TX
Practice Address - Zip Code:75969-3223
Practice Address - Country:US
Practice Address - Phone:936-635-6649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310150164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse