Individual
MARY E WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-6671
Mailing address
502 3RD ST, PO BOX 184, WINCHESTER, KS 66097-4152
(913) 774-2024
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
1378828-102
KS
Other
Enumeration date
09/16/2008
Last updated
09/16/2008
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