| Doctor Name: | MARY E WILLIS |
| NPI Number: | 1346499241 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 1378828-102 |
| Business Practice Address: | 550 Pope Ave Fort Leavenworth, KS - 660272332 |
| Business Phone Number: | 9136846671 |
| Business Fax Number: | |
| Mailing Address: | 502 3rd St, Po Box 184 WINCHESTER |
| State: | KS |
| Postal Code: | 660974152 |
| Phone Number: | 9137742024 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2008 |
| NPI Last Update Date: | 09/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 1378828-102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |