| NPI | 1659510279 |
|---|---|
| Former Name | ERICA NICOLE WILLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-1699) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-01699) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-01699) | |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2021-02-24 |