Individual
MISS KATHLEEN MICHELLE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COMMUNITY HEALTH WOR
Contact information
Practice address
715 S CENTRAL AVE, ELY, MN 55731-1337
(218) 235-9539
(218) 235-7843
Mailing address
PO BOX 714, ELY, MN 55731-0714
(218) 235-9539
(218) 365-7843
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
MN
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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