Individual
SHAWN DALE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
67 VICKERS BRANCH RD, CHAPMANVILLE, WV 25508-9716
(304) 855-1959
Mailing address
67 VICKERS BRANCH RD, CHAPMANVILLE, WV 25508-9716
(304) 855-1959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN66325-FNP-BC
WV
363LF0000X
Family Nurse Practitioner
Primary
APRN66325-FNP-BC
WV
Other
Enumeration date
08/03/2016
Last updated
09/19/2024
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