Individual
CLARESSA FAY WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9046 221ST, QUEENS VILLAGE, NY 11428
(718) 528-3432
Mailing address
90-46 221ST, QUEENS VILLAGE, NY 11428
(718) 528-3432
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
271519
NY
Other
Enumeration date
04/14/2010
Last updated
04/14/2010
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