Provider Demographics
NPI:1871833483
Name:WILLS, SONJA M (NP-C)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:M
Last Name:WILLS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4241
Mailing Address - Fax:615-425-4268
Practice Address - Street 1:1425 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8258
Practice Address - Country:US
Practice Address - Phone:513-282-3010
Practice Address - Fax:513-282-3011
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.315594363LF0000X
OHAPRN.CNP.14335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1871833483Medicaid