| Doctor Name: | JEANINE R WILLIS |
| NPI Number: | 1356776975 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | COA.15100-NP |
| Business Practice Address: | 5319 Meadow Lane Ct Sheffield Village, OH - 440351469 |
| Business Phone Number: | 4409345575 |
| Business Fax Number: | 4409345579 |
| Mailing Address: | 24701 Euclid Ave, Third Floor Billing Services EUCLID |
| State: | OH |
| Postal Code: | 441171714 |
| Phone Number: | 4409345575 |
| Fax Number: | 4409345579 |
| NPI Enumeration Date: | 09/13/2013 |
| NPI Last Update Date: | 06/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA.15100-NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |