Individual
AMANDA L WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-0816
(434) 924-2283
(434) 982-0019
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
0110009670
VA
363A00000X
Physician Assistant
Primary
0110009670
VA
Other
Enumeration date
11/17/2023
Last updated
12/09/2023
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