Individual
MARY JO WILLIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2880 UNIVERSITY AVE, MADISON, WI 53705
(608) 263-7500
(608) 833-6932
Mailing address
8007 EXCELSIOR DRIVE, MADISON, WI 53717
(608) 829-5201
(608) 833-6932
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
43266
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43829500
—
WI
Enumeration date
04/12/2006
Last updated
07/08/2007
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