Individual
DUSTY MAHEALANI WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
100 VETERANS MEMORIAL DR, BOULDER CITY, NV 89005-1926
(702) 332-6784
Mailing address
177 VITALE AVE, HENDERSON, NV 89002-9208
(808) 387-4705
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
835700
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPN-10376
HAWAII BOARD OF NURSING - PVL
HI
Enumeration date
05/21/2022
Last updated
05/21/2022
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