Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP135335 | TX |
NPI | 1003331687 |
---|---|
Provider Name | Erane Willis |
First Address | Cedar Hill, TX 75104-2206 |
Second Address | Cedar Hill, TX 75104-2206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 21/02/2020 |