Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2020-02126 | NC |
NPI | 1003340662 |
---|---|
Provider Name | Elizabeth Willis |
First Address | Durham, NC 27707-5521 |
Second Address | Chapel Hill, NC 27599-7220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 07/05/2021 |