Doctor Name: | MRS. RENEE L WILLER |
NPI Number: | 1477530814 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 138512 |
Business Practice Address: | 4581 Gravois Rd House Springs, MO - 630511374 |
Business Phone Number: | 6366719980 |
Business Fax Number: | 6366719981 |
Mailing Address: | 4581 Gravois Rd, HOUSE SPRINGS |
State: | MO |
Postal Code: | 630511374 |
Phone Number: | 6366719980 |
Fax Number: | 6366719981 |
NPI Enumeration Date: | 12/28/2005 |
NPI Last Update Date: | 07/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 138512 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |