Individual
DIANE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1391 NW 136TH AVE, SUNRISE, FL 33323-2800
(609) 964-9492
Mailing address
1391 NW 136TH AVE, SUNRISE, FL 33323-2800
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
NR06724700
NJ
Other
Enumeration date
02/02/2022
Last updated
02/02/2022
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