| Doctor Name: | JACQUELINE EVA WILLIS |
| NPI Number: | 1073908281 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | CNP02617 |
| Business Practice Address: | 4101 Barbara Loop Se Suite D Rio Rancho, NM - 871241009 |
| Business Phone Number: | 5058926348 |
| Business Fax Number: | |
| Mailing Address: | 4101 Barbara Loop Se, Suite D RIO RANCHO |
| State: | NM |
| Postal Code: | 871241009 |
| Phone Number: | 5058926348 |
| Fax Number: | |
| NPI Enumeration Date: | 04/03/2015 |
| NPI Last Update Date: | 04/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | CNP02617 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |