Organization
WILLIS HEALTH CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK G WILLIS NP (OWNER)
(208) 705-2575
Entity
Organization
Contact information
Practice address
1350 CEDAR LAKE RD, POCATELLO, ID 83204-4946
(208) 705-2575
(208) 203-1348
Mailing address
1350 CEDAR LAKE RD, POCATELLO, ID 83204-4946
(208) 705-2575
(208) 203-1348
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/23/2020
Last updated
12/23/2020
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