Individual
DENISE BOYD WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
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
Update your record
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