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Individual

TERESA HALLEY WILLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
3421 MEDICAL PARK DR, MONROE, LA 71203-2355
(318) 388-7890
Mailing address
240 CHAPMAN JOHNSON RD, CALHOUN, LA 71225-8669
(318) 547-9400

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN031851 APO1344
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1900443
LA
Enumeration date
01/29/2007
Last updated
11/05/2007
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