Provider Demographics
NPI:1295054146
Name:HUNTINGTON, WILLA MARIE (NURSE LPN)
Entity type:Individual
Prefix:
First Name:WILLA
Middle Name:MARIE
Last Name:HUNTINGTON
Suffix:
Gender:F
Credentials:NURSE LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 DEFIANCE ST
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1405
Mailing Address - Country:US
Mailing Address - Phone:518-585-6042
Mailing Address - Fax:
Practice Address - Street 1:53 DEFIANCE ST
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1405
Practice Address - Country:US
Practice Address - Phone:518-585-6042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270460-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse