Provider Demographics
NPI:1134208077
Name:WILLIS, MARGARET DEAN (FNP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:DEAN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S RIDGEOAK CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-6461
Mailing Address - Country:US
Mailing Address - Phone:214-405-0056
Mailing Address - Fax:
Practice Address - Street 1:206 STORRS ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4006
Practice Address - Country:US
Practice Address - Phone:972-772-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203420901Medicaid
TXP03059Medicare UPIN
TX8F20757Medicare PIN
TX8C8506Medicare ID - Type Unspecified