Provider Demographics
NPI:1972942605
Name:IFILL, WILLIS EUSTON II
Entity Type:Individual
Prefix:MR
First Name:WILLIS
Middle Name:EUSTON
Last Name:IFILL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 THUNDER RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2215
Mailing Address - Country:US
Mailing Address - Phone:702-492-7358
Mailing Address - Fax:
Practice Address - Street 1:1983 THUNDER RIDGE CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2215
Practice Address - Country:US
Practice Address - Phone:702-492-7358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner