Individual
ELIZABETH ADRIENNE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MS, PMHNP-BC
Contact information
Practice address
6 TARMAN DR, CLOVERDALE, CA 95425-3932
(707) 894-4229
Mailing address
PO BOX 253, SEBASTOPOL, CA 95473-0253
(707) 921-9393
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
793320
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95017303
CA
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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