Individual
MS. PHYLLIS ANN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
404 N KEENE ST, COLUMBIA, MO 65201-6626
(573) 875-9224
(573) 875-9284
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
108842
MO
367500000X
Certified Registered Nurse Anesthetist
R0032281
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
914449004
—
MO
01
—
P00400212
RAIL ROAD MEDICARE
MO
Enumeration date
08/05/2006
Last updated
07/15/2019
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