Individual
NICHOLAS WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 W 40TH AVE, SUITE 301, PINE BLUFF, AR 71603-6319
(870) 541-4285
(870) 541-4297
Mailing address
1601 W 40TH AVE, SUITE 301, PINE BLUFF, AR 71603-6319
(870) 541-4285
(870) 541-4297
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
E5292
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168857001
—
AR
Enumeration date
04/12/2007
Last updated
10/19/2020
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