Provider Demographics
NPI:1467863555
Name:WILLIS, LAURA M (DNP, APRN-CNP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DNP, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2688
Mailing Address - Country:US
Mailing Address - Phone:937-523-9050
Mailing Address - Fax:937-523-9059
Practice Address - Street 1:200 MEDICAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2688
Practice Address - Country:US
Practice Address - Phone:937-523-9050
Practice Address - Fax:937-523-9059
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104805Medicaid
OH0104805Medicaid