Provider Demographics
NPI:1184118697
Name:WILLIS, SARAH PHILLIPS (RN, CLC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:PHILLIPS
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HICKORY TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-7908
Mailing Address - Country:US
Mailing Address - Phone:931-309-8118
Mailing Address - Fax:
Practice Address - Street 1:109 HICKORY TRAIL DR
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-7908
Practice Address - Country:US
Practice Address - Phone:931-309-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-143055163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant