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Individual
LYLE DAVID WILLOCK
Active
Individual
LYLE DAVID WILLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RNFA, PA, ROPA-C
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
R0773991
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73B62WI
BLUECROSS BLUESHIELD
—
01
—
969991011727
PREFERREDONE
—
01
—
HP43945
HEALTHPARTNERS
—
Enumeration date
08/23/2006
Last updated
07/11/2007
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