Individual
GREGORY WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 STAHLHUT DR, LINCOLN, IL 62656-5066
(217) 732-2161
(217) 735-3526
Mailing address
1015 STATE ROUTE 121, LINCOLN, IL 62656-5355
(217) 792-3864
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209-001819
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37699
RECERTIFICATION OF CRNA
IL
Enumeration date
04/20/2007
Last updated
03/30/2011
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