Individual
IRENE CRYSTAL WILLITS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 729-7585
Mailing address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
(541) 682-3551
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201403163LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201403163LPN
OREGON BOARD OF NURSING LICENSE
OR
Enumeration date
01/24/2018
Last updated
02/26/2018
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