Provider Demographics
NPI:1871825240
Name:WILLISON, IRENE MARY (RN)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:MARY
Last Name:WILLISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 REUTER LN
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1200
Mailing Address - Country:US
Mailing Address - Phone:503-357-1602
Mailing Address - Fax:
Practice Address - Street 1:334 REUTER LN
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1200
Practice Address - Country:US
Practice Address - Phone:503-357-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28599163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse