Provider Demographics
NPI:1831385731
Name:WILLIS, ELIZABETH ANN (RN, BSN)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-0209
Mailing Address - Country:US
Mailing Address - Phone:423-357-5341
Mailing Address - Fax:
Practice Address - Street 1:247 SILVER LAKE RD.
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:TN
Practice Address - Zip Code:37642-0209
Practice Address - Country:US
Practice Address - Phone:423-357-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN162524163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3170197Medicare PIN
TNB58933Medicare UPIN