Individual
MICHAEL DAVID RUSSELL WILLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-4817
(570) 271-6621
(570) 271-6762
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
162278
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
RN653658
PA
Other
Enumeration date
08/30/2013
Last updated
05/02/2018
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