Provider Demographics
NPI:1720163280
Name:PERSON, WILLIE DEWRENA (RN)
Entity Type:Individual
Prefix:MRS
First Name:WILLIE
Middle Name:DEWRENA
Last Name:PERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 E 117TH ST
Mailing Address - Street 2:
Mailing Address - City:KC
Mailing Address - State:MO
Mailing Address - Zip Code:64134
Mailing Address - Country:US
Mailing Address - Phone:816-554-5519
Mailing Address - Fax:816-554-5550
Practice Address - Street 1:6801 E 117TH ST
Practice Address - Street 2:
Practice Address - City:KC
Practice Address - State:MO
Practice Address - Zip Code:64134
Practice Address - Country:US
Practice Address - Phone:816-554-5519
Practice Address - Fax:816-554-5550
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO090891163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse