Provider Demographics
NPI:1942241492
Name:WILLIS, CHRISTINA L (NP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:L
Last Name:WILLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:FUCHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:3310 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1000
Practice Address - Country:US
Practice Address - Phone:630-897-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006543363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK38874Medicare PIN
Q71220Medicare UPIN
ILK38873Medicare PIN