Individual
JACQUELYN WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5901 SHANA DR, COLUMBUS, OH 43232-1627
(614) 353-4985
Mailing address
5901 SHANA DR, COLUMBUS, OH 43232-1627
(614) 353-4985
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
SA143610
OH
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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