Individual
BRENT WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
203 LA GRANGE DR., TEXARKANA, TX 75501
(936) 645-5428
Mailing address
203 LA GRANGE DR., TEXARKANA, TX 75501
(936) 645-5428
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP133014
TX
Other
Enumeration date
01/27/2017
Last updated
01/27/2017
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