Individual
MR. PHILIP EDWARD WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1805 27TH ST, PORTSMOUTH, OH 45662-2640
(740) 356-8231
(740) 356-3686
Mailing address
1735 27TH ST STE B06, PORTSMOUTH, OH 45662-2681
(740) 356-6942
(740) 356-7851
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
3117A
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.06745
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2213410
—
OH
05
—
74002312
—
KY
Enumeration date
01/23/2006
Last updated
12/16/2020
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