Individual
MS. KONNEEN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1551 RENAISSANCE TOWNE DR, STE 460, BOUNTIFUL, UT 84010-7667
(801) 294-7246
(801) 294-2560
Mailing address
1551 RENAISSANCE TOWNE DR, STE 540, BOUNTIFUL, UT 84010-7678
(801) 408-7660
(801) 408-7650
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
107354-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861510240
—
UT
Enumeration date
03/26/2007
Last updated
02/25/2021
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