Individual
DENISE BOYD WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5303 PLAZA DR, SUITE 101, HOPEWELL, VA 23860-7331
(804) 458-2006
(804) 458-3629
Mailing address
3912 SCHOONER LANE, HOPEWELL, VA 23860
(804) 892-3480
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0110001909
VA
363AM0700X
Medical Physician Assistant
Primary
0110001909
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007691084
—
VA
01
—
0110001909
VA STATE MEDICAL LICENSE
VA
Enumeration date
12/15/2005
Last updated
06/04/2013
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