Individual
LATANYA MARIA WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9675 W CAMELBACK RD, PHOENIX, AZ 85037-3667
(844) 646-3247
Mailing address
12324 N 144TH DR, SURPRISE, AZ 85379-4477
(216) 798-3926
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
330479
OH
163WP0200X
Pediatric Registered Nurse
330479
OH
363LF0000X
Family Nurse Practitioner
832010
TX
363LF0000X
Family Nurse Practitioner
AP8888
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP8888
AZ
Other
Enumeration date
06/27/2007
Last updated
09/29/2023
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