Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 95000838 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 448756 | CA |
NPI | 1053729012 |
---|---|
Provider Name | Sharon Leitzel Willis |
First Address | Santa Barbara, CA 93101-1624 |
Second Address | Santa Barbara, CA 93108-1023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2014 |
Last Update Date | 07/05/2019 |