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Individual
SUSAN M. WILLIS
Active
Individual
SUSAN M. WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
542468
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP101864
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126080404
—
TX
01
—
89479C
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/14/2005
Last updated
12/09/2021
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