| Doctor Name: | MRS. HAIDY DENISE WILLIS |
| NPI Number: | 1023395142 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PMHNP |
| License Number: | NP 22719 |
| Business Practice Address: | 10333 El Camino Real Atascadero, CA - 934225808 |
| Business Phone Number: | 8054682000 |
| Business Fax Number: | 8054686011 |
| Mailing Address: | 1600 9th Street, Room 150, Fiscal Allocations And Estimates Unit SACRAMENTO |
| State: | CA |
| Postal Code: | 958146414 |
| Phone Number: | 9166519475 |
| Fax Number: | 9166518908 |
| NPI Enumeration Date: | 11/03/2011 |
| NPI Last Update Date: | 07/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | NP 22719 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |