Individual
MRS. LA JUANA DELL WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
600 GALLEGOS, LOGAN, NM 88426-7602
(575) 487-9000
(575) 487-9002
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP00145
NM
363LF0000X
Family Nurse Practitioner
R14626
NM
Other
Enumeration date
08/23/2006
Last updated
10/21/2019
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