Provider Demographics
NPI:1134770993
Name:WILLIS, SANDY DAWN (CNA1)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:DAWN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:CNA1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 GREENFIELD CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28578-8685
Mailing Address - Country:US
Mailing Address - Phone:919-440-8037
Mailing Address - Fax:
Practice Address - Street 1:3905 CENTRAL HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-7905
Practice Address - Country:US
Practice Address - Phone:919-440-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health