Individual
JEANINE R WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
18099 LORAIN AVE STE 445, CLEVELAND, OH 44111-5610
(440) 886-1800
Mailing address
18099 LORAIN AVE STE 445, CLEVELAND, OH 44111-5610
(440) 886-1800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
COA.15100-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096370
—
OH
Enumeration date
09/13/2013
Last updated
01/22/2023
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