| NPI | 1194975888 |
|---|---|
| Former Name | LAUREL L. WILLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA053530) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA MA053530) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2023-11-07 |