Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 34.013207 | OH |
Y | 2080P0204X | Pediatric Emergency Doctor | 34.013207 | OH |
NPI | 1013337716 |
---|---|
Provider Name | Bryce Lawrence Willen |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 07/07/2021 |