Individual
NISHAE LATRICE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
7315 ALBRIGHT AVE, SAINT LOUIS, MO 63136-1228
(314) 699-1166
Mailing address
7315 ALBRIGHT AVE, SAINT LOUIS, MO 63136-1228
(314) 699-1166
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
V137105002
MO
Other
Enumeration date
07/05/2022
Last updated
07/05/2022
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